{
  "version": "2026-Q1",
  "formal_id": "HV-Policy-2026-Q1",
  "generated_at": "2026-04-02T00:19:07.939Z",
  "license": "CC BY 4.0",
  "license_url": "https://creativecommons.org/licenses/by/4.0/",
  "citation": "The Headache Vault Payer Policy Database, 2026-Q1. The Headache Vault, LLC. https://headachevault.com/research. Licensed under CC BY 4.0.",
  "record_counts": {
    "payers": 1204,
    "policies": 870,
    "formulary_entries": 6696
  },
  "data": {
    "payer_registry": {
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        {
          "name": "Aetna",
          "slug": "AETNA",
          "id": "AK-COM-AETNA",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "CVS Health",
          "pbm": "CVS Caremark",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Moda Health",
          "slug": "MODA",
          "id": "AK-COM-MODA",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "Moda Health",
          "pbm": "MedImpact",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Premera Blue Cross",
          "slug": "PREMBC",
          "id": "AK-COM-PREMBC",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "Premera Blue Cross",
          "pbm": "Prime Therapeutics",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "UnitedHealthcare",
          "slug": "UHC",
          "id": "AK-COM-UHC",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "UnitedHealth Group",
          "pbm": "OptumRx",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Aetna Medicare",
          "slug": "AETNACARE",
          "id": "AK-MA-AETNACARE",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "CVS Health",
          "pbm": "CVS Caremark",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Humana",
          "slug": "HUMANA",
          "id": "AK-MA-HUMANA",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "Humana Inc.",
          "pbm": "Humana Pharmacy Solutions",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Premera Blue Cross",
          "slug": "PREMERA",
          "id": "AK-MA-PREMERA",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "Premera",
          "pbm": "Prime Therapeutics",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "UnitedHealthcare",
          "slug": "UHC",
          "id": "AK-MA-UHC",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "UnitedHealth Group",
          "pbm": "OptumRx",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Premera BCBS Alaska",
          "slug": "premera-ak",
          "id": "AK-COM-PREMERA",
          "lob": "Commercial",
          "lobCode": "COM",
          "parent": "Premera",
          "pbm": "Premera PBM",
          "url": "https://www.prior auth.premera.com/",
          "turnaround": "Standard",
          "expedited": "Expedited",
          "goldCard": "⚠️ SB 133 effective 2027 (shadow compliance 2026)",
          "channel": "Premera Portal"
        },
        {
          "name": "Alaska Medicaid (DenaliCare)",
          "slug": "denalicare-ak",
          "id": "AK-MCD-DENALI",
          "lob": "Medicaid",
          "lobCode": "MCD",
          "parent": "AK DHSS",
          "pbm": "AK Medicaid PBM",
          "url": "https://health.alaska.gov/",
          "turnaround": "Standard",
          "expedited": "Expedited",
          "goldCard": "N/A - Medicaid",
          "channel": "AK Medicaid Portal"
        },
        {
          "name": "Noridian Healthcare Solutions (AK)",
          "slug": "noridian-jf-ak",
          "id": "AK-PARTB-NORIDIAN",
          "lob": "PARTB",
          "lobCode": "PARTB",
          "parent": "Noridian",
          "pbm": null,
          "url": "https://med.noridianmedicare.com/",
          "turnaround": "LCD",
          "expedited": null,
          "goldCard": "N/A - Federal",
          "channel": "Noridian Portal"
        },
        {
          "name": "Alaska Denali KidCare - All plans",
          "slug": "denalikidcare-ak-chip",
          "id": "AK-CHIP-DENALIKIDCARE",
          "lob": "CHIP",
          "lobCode": "CHIP",
          "parent": "State of Alaska",
          "pbm": "AK DHSS",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Noridian Healthcare Solutions (AK)",
          "slug": "NORIDIAN",
          "id": "AK-MAC-NORIDIAN",
          "lob": "Medicare MAC",
          "lobCode": "MAC",
          "parent": "Noridian",
          "pbm": "N/A - Medical Benefit",
          "url": "https://med.noridianmedicare.com/",
          "turnaround": "N/A - Post-service",
          "expedited": "N/A - Post-service",
          "goldCard": "N/A - Federal Medicare",
          "channel": "Claims-based / LCD compliance"
        },
        {
          "name": "Premera BCBS AK",
          "slug": "PREMERA-CLUSTER",
          "id": "AK-COM-PREMERA-CLUSTER",
          "lob": "COM",
          "lobCode": "COM",
          "parent": null,
          "pbm": null,
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        }
      ],
      "AZ": [
        {
          "name": "Aetna",
          "slug": "AETNA",
          "id": "AZ-COM-AETNA",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "CVS Health",
          "pbm": "CVS Caremark",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Blue Cross Blue Shield of Arizona",
          "slug": "BCBSAZ",
          "id": "AZ-COM-BCBSAZ",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "BCBSAZ",
          "pbm": "Prime Therapeutics",
          "url": "https://www.azblue.com/",
          "turnaround": "Standard",
          "expedited": "Expedited",
          "goldCard": "✓ Gold Card 80%",
          "channel": "BCBSAZ Portal"
        },
        {
          "name": "Cigna",
          "slug": "CIGNA",
          "id": "AZ-COM-CIGNA",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "Cigna",
          "pbm": "Express Scripts",
          "url": "https://www.cigna.com/providers/",
          "turnaround": "Standard",
          "expedited": "Expedited",
          "goldCard": "Statutory",
          "channel": "Cigna Portal"
        },
        {
          "name": "Oscar Health",
          "slug": "OSCAR",
          "id": "AZ-COM-OSCAR",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "Oscar Health",
          "pbm": "Express Scripts",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "UnitedHealthcare",
          "slug": "UHC",
          "id": "AZ-COM-UHC",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "UnitedHealth Group",
          "pbm": "OptumRx",
          "url": "https://www.uhcprovider.com/",
          "turnaround": "Standard",
          "expedited": "Expedited",
          "goldCard": "✓ Gold Card (Oct 2024)",
          "channel": "Optum Pro Portal"
        },
        {
          "name": "Aetna Better Health of Arizona",
          "slug": "AETNABETTER",
          "id": "AZ-MCD-AETNABETTER",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "CVS Health",
          "pbm": "CVS Caremark",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Arizona Complete Health",
          "slug": "AZCOMPLETE",
          "id": "AZ-MCD-AZCOMPLETE",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "Centene",
          "pbm": "Envolve Pharmacy Solutions",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Banner University Family Care",
          "slug": "BANNER",
          "id": "AZ-MCD-BANNER",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "Banner Health",
          "pbm": "Express Scripts",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Care1st Health Plan Arizona",
          "slug": "CAREFIRST",
          "id": "AZ-MCD-CAREFIRST",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "Blue Cross Blue Shield of Arizona",
          "pbm": "Prime Therapeutics",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Health Choice Arizona",
          "slug": "HEALTHCHOICE",
          "id": "AZ-MCD-HEALTHCHOICE",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "Steward Health Care",
          "pbm": "Express Scripts",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Mercy Care",
          "slug": "MERCYCARE",
          "id": "AZ-MCD-MERCYCARE",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "Aetna/CVS Health - Molina JV",
          "pbm": "CVS Caremark",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "UnitedHealthcare Community Plan",
          "slug": "UHC",
          "id": "AZ-MCD-UHC",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "UnitedHealth Group",
          "pbm": "OptumRx",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Aetna Medicare",
          "slug": "AETNACARE",
          "id": "AZ-MA-AETNACARE",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "CVS Health",
          "pbm": "CVS Caremark",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Banner University Family Care",
          "slug": "BANNER",
          "id": "AZ-MA-BANNER",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "Banner Health",
          "pbm": "Express Scripts",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Cigna HealthSpring",
          "slug": "CIGNA",
          "id": "AZ-MA-CIGNA",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "Cigna",
          "pbm": "Express Scripts",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Humana",
          "slug": "HUMANA",
          "id": "AZ-MA-HUMANA",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "Humana Inc.",
          "pbm": "Humana Pharmacy Solutions",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "UnitedHealthcare",
          "slug": "UHC",
          "id": "AZ-MA-UHC",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "UnitedHealth Group",
          "pbm": "OptumRx",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "AHCCCS Fee-For-Service",
          "slug": "ahcccs-ffs",
          "id": "AZ-MCD-AHCCCS",
          "lob": "Medicaid FFS",
          "lobCode": "MCD",
          "parent": "AZ Health Care Cost Containment System",
          "pbm": "OptumRx",
          "url": "https://azahcccs.gov/",
          "turnaround": "14 days",
          "expedited": "72 hours",
          "goldCard": "N/A - Medicaid",
          "channel": "AHCCCS Portal"
        },
        {
          "name": "Noridian Healthcare Solutions (AZ)",
          "slug": "noridian-jf-az",
          "id": "AZ-PARTB-NORIDIAN",
          "lob": "PARTB",
          "lobCode": "PARTB",
          "parent": "Noridian Healthcare Solutions",
          "pbm": null,
          "url": "https://med.noridianmedicare.com/",
          "turnaround": "LCD",
          "expedited": null,
          "goldCard": "N/A - WISeR Pilot",
          "channel": "Noridian Portal"
        },
        {
          "name": "Arizona KidsCare - AHCCCS",
          "slug": "ahcccs-az-chip",
          "id": "AZ-CHIP-AHCCCS",
          "lob": "CHIP",
          "lobCode": "CHIP",
          "parent": "State of Arizona",
          "pbm": "AZ AHCCCS",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Arizona KidsCare - UnitedHealthcare CP",
          "slug": "uhc-az-chip",
          "id": "AZ-CHIP-UHC",
          "lob": "CHIP",
          "lobCode": "CHIP",
          "parent": "UnitedHealth Group",
          "pbm": "OptumRx",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Arizona KidsCare - Molina",
          "slug": "molina-az-chip",
          "id": "AZ-CHIP-MOLINA",
          "lob": "CHIP",
          "lobCode": "CHIP",
          "parent": "Molina Healthcare",
          "pbm": "CVS Caremark",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Arizona KidsCare - Mercy Care",
          "slug": "mercycare-az-chip",
          "id": "AZ-CHIP-MERCYCARE",
          "lob": "CHIP",
          "lobCode": "CHIP",
          "parent": "Aetna/CVS",
          "pbm": "CVS Caremark",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Noridian Healthcare Solutions (AZ)",
          "slug": "NORIDIAN",
          "id": "AZ-MAC-NORIDIAN",
          "lob": "Medicare MAC",
          "lobCode": "MAC",
          "parent": "Noridian",
          "pbm": "N/A - Medical Benefit",
          "url": "https://med.noridianmedicare.com/",
          "turnaround": "N/A - Post-service",
          "expedited": "N/A - Post-service",
          "goldCard": "N/A - Federal Medicare",
          "channel": "Claims-based / LCD compliance"
        },
        {
          "name": "BCBS Arizona",
          "slug": "BCBSAZ-CLUSTER",
          "id": "AZ-COM-BCBSAZ-CLUSTER",
          "lob": "COM",
          "lobCode": "COM",
          "parent": null,
          "pbm": null,
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Antidote Health Plan of Arizona",
          "slug": "ANTIDOTE",
          "id": "AZ-COM-ANTIDOTE",
          "lob": "COM",
          "lobCode": "COM",
          "parent": null,
          "pbm": null,
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Imperial Insurance Companies Inc.",
          "slug": "IMPERIAL",
          "id": "AZ-COM-IMPERIAL",
          "lob": "COM",
          "lobCode": "COM",
          "parent": null,
          "pbm": null,
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        }
      ],
      "CA": [
        {
          "name": "Aetna",
          "slug": "AETNA",
          "id": "CA-COM-AETNA",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "CVS Health",
          "pbm": "CVS Caremark",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Anthem Blue Cross",
          "slug": "ANTHEMBC",
          "id": "CA-COM-ANTHEMBC",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "Elevance Health",
          "pbm": "IngenioRx (Carelon)",
          "url": "https://providers.anthem.com/docs/gpp/PHARM_ALL_Aimovig.pdf",
          "turnaround": "7 days",
          "expedited": "72 hours",
          "goldCard": "SB 306 - data calibration 2026; exemptions 2028",
          "channel": "Portal"
        },
        {
          "name": "Blue Shield of California",
          "slug": "BSCA",
          "id": "CA-COM-BSCA",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "Blue Shield of CA",
          "pbm": "Prime Therapeutics",
          "url": "https://www.blueshieldca.com/bin/cms/bsca/services/portal/provider/StreamDocumentServlet?fileName=PRV_Aimovig_Ajovy_Emgality_COMMext.pdf",
          "turnaround": "7 days",
          "expedited": "72 hours",
          "goldCard": "SB 306 - data calibration 2026; exemptions 2028",
          "channel": "Portal"
        },
        {
          "name": "Health Net",
          "slug": "HNET",
          "id": "CA-COM-HNET",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "Centene",
          "pbm": "Express Scripts",
          "url": "https://www.healthnet.com/providers",
          "turnaround": "7 days",
          "expedited": "72 hours",
          "goldCard": "SB 306 - data calibration 2026; exemptions 2028",
          "channel": "Portal"
        },
        {
          "name": "Kaiser Permanente",
          "slug": "KAISER",
          "id": "CA-COM-KAISER",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "Kaiser Foundation Health Plan",
          "pbm": "Kaiser Permanente (Internal)/MedImpact",
          "url": "https://healthy.kaiserpermanente.org/content/dam/kporg/final/documents/health-plan-documents/coverage-information/clinical-review-botox-chronic-migraine-policy-nw.pdf",
          "turnaround": "7 days",
          "expedited": "72 hours",
          "goldCard": "SB 306 - data calibration 2026; exemptions 2028",
          "channel": "Internal referral system"
        },
        {
          "name": "UnitedHealthcare",
          "slug": "UHC",
          "id": "CA-COM-UHC",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "UnitedHealth Group",
          "pbm": "OptumRx",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Anthem Blue Cross (Medi-Cal)",
          "slug": "ANTHEM",
          "id": "CA-MCD-ANTHEM",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "Elevance Health",
          "pbm": "IngenioRx (Carelon)",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Blue Shield of California Promise",
          "slug": "PROMISEBS",
          "id": "CA-MCD-PROMISEBS",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "Blue Shield of California",
          "pbm": "Prime Therapeutics",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "CalOptima",
          "slug": "CALOPTIMA",
          "id": "CA-MCD-CALOPTIMA",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "CalOptima (County-based)",
          "pbm": "OptumRx",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Centene (Health Net)",
          "slug": "CENTENE",
          "id": "CA-MCD-CENTENE",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "Centene",
          "pbm": "Envolve Pharmacy Solutions",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Inland Empire Health Plan",
          "slug": "INLANDHEALTH",
          "id": "CA-MCD-INLANDHEALTH",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "IEHP (County-based)",
          "pbm": "OptumRx",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Kaiser Permanente",
          "slug": "KAISER",
          "id": "CA-MCD-KAISER",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "Kaiser Permanente",
          "pbm": "Kaiser Permanente (Internal)",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "L.A. Care Health Plan",
          "slug": "LACAREHEALTH",
          "id": "CA-MCD-LACAREHEALTH",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "L.A. Care (County-based)",
          "pbm": "Navitus Health Solutions",
          "url": "https://www.lacare.org/providers",
          "turnaround": "7 days",
          "expedited": "72 hours",
          "goldCard": "N/A - Medicaid",
          "channel": "Portal (IPA delegation)"
        },
        {
          "name": "Molina Healthcare of California",
          "slug": "MOLINA",
          "id": "CA-MCD-MOLINA",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "Molina Healthcare",
          "pbm": "CVS Caremark",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Partnership HealthPlan of California",
          "slug": "PARTHEALTH",
          "id": "CA-MCD-PARTHEALTH",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "Partnership Health Plan",
          "pbm": "MedImpact",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Aetna Medicare",
          "slug": "AETNACARE",
          "id": "CA-MA-AETNACARE",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "CVS Health",
          "pbm": "CVS Caremark",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Alignment Healthcare",
          "slug": "ALIGN",
          "id": "CA-MA-ALIGN",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "Alignment Healthcare",
          "pbm": "CVS Caremark",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Blue Shield of California",
          "slug": "CABCBS",
          "id": "CA-MA-CABCBS",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "Blue Shield of CA",
          "pbm": "Prime Therapeutics",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Humana",
          "slug": "HUMANA",
          "id": "CA-MA-HUMANA",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "Humana Inc.",
          "pbm": "Humana Pharmacy Solutions",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Kaiser Permanente",
          "slug": "KAISER",
          "id": "CA-MA-KAISER",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "Kaiser Foundation Health Plan",
          "pbm": "Kaiser Permanente (Internal)/MedImpact",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "SCAN Health Plan",
          "slug": "SCANHEALTH",
          "id": "CA-MA-SCANHEALTH",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "SCAN Group",
          "pbm": "OptumRx",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "UnitedHealthcare",
          "slug": "UHC",
          "id": "CA-MA-UHC",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "UnitedHealth Group",
          "pbm": "OptumRx",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Medi-Cal Rx (DHCS)",
          "slug": "MEDICALRX",
          "id": "CA-MCD-MEDICALRX",
          "lob": "MCD-RX",
          "lobCode": "MCD",
          "parent": "California DHCS",
          "pbm": "Magellan Rx",
          "url": "https://medi-calrx.dhcs.ca.gov/cms/medicalrx/static-assets/documents/provider/forms-and-information/cdl/Medi-Cal_Rx_Contract_Drugs_List_FINAL.pdf",
          "turnaround": "7 days",
          "expedited": "72 hours",
          "goldCard": "N/A - State Medicaid",
          "channel": "Portal + Fax"
        },
        {
          "name": "Noridian Healthcare Solutions",
          "slug": "NORIDIAN",
          "id": "CA-PARTB-NORIDIAN",
          "lob": "PARTB",
          "lobCode": "PARTB",
          "parent": "Noridian Healthcare Solutions",
          "pbm": null,
          "url": "https://med.noridianmedicare.com/web/jeb",
          "turnaround": "7 days",
          "expedited": "72 hours",
          "goldCard": "N/A - Federal Medicare",
          "channel": "Portal"
        },
        {
          "name": "California Medi-Cal CHIP - Anthem Blue Cross",
          "slug": "anthem-ca-chip",
          "id": "CA-CHIP-ANTHEM",
          "lob": "CHIP",
          "lobCode": "CHIP",
          "parent": "Elevance Health",
          "pbm": "Elevance PBM",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "California Medi-Cal CHIP - Health Net",
          "slug": "healthnet-ca-chip",
          "id": "CA-CHIP-HEALTHNET",
          "lob": "CHIP",
          "lobCode": "CHIP",
          "parent": "Centene",
          "pbm": "Centene PBM",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "California Medi-Cal CHIP - Kaiser Permanente",
          "slug": "kaiser-ca-chip",
          "id": "CA-CHIP-KAISER",
          "lob": "CHIP",
          "lobCode": "CHIP",
          "parent": "Kaiser Permanente",
          "pbm": "Kaiser PBM",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "California Medi-Cal CHIP - Molina",
          "slug": "molina-ca-chip",
          "id": "CA-CHIP-MOLINA",
          "lob": "CHIP",
          "lobCode": "CHIP",
          "parent": "Molina Healthcare",
          "pbm": "CVS Caremark",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "California Medi-Cal CHIP - LA Care",
          "slug": "lacare-ca-chip",
          "id": "CA-CHIP-LACARE",
          "lob": "CHIP",
          "lobCode": "CHIP",
          "parent": "LA Care Health Plan",
          "pbm": "LA Care PBM",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Noridian Healthcare Solutions (CA)",
          "slug": "NORIDIAN",
          "id": "CA-MAC-NORIDIAN",
          "lob": "Medicare MAC",
          "lobCode": "MAC",
          "parent": "Noridian",
          "pbm": "N/A - Medical Benefit",
          "url": "https://med.noridianmedicare.com/",
          "turnaround": "N/A - Post-service",
          "expedited": "N/A - Post-service",
          "goldCard": "N/A - Federal Medicare",
          "channel": "Claims-based / LCD compliance"
        },
        {
          "name": "L.A. Care Health Plan",
          "slug": "LACARE",
          "id": "CA-MCD-LACARE",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "L.A. Care",
          "pbm": "State SPBM",
          "url": "https://www.lacare.org/",
          "turnaround": "7 days",
          "expedited": "72 hours",
          "goldCard": "N/A - Medicaid",
          "channel": "State Medicaid Portal"
        },
        {
          "name": "L.A. Care Health Plan",
          "slug": "LACARE-CLUSTER",
          "id": "CA-MCD-LACARE-CLUSTER",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": null,
          "pbm": null,
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Medi-Cal",
          "slug": "MEDICAL",
          "id": "CA-MCD-MEDICAL",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": null,
          "pbm": null,
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Medi-Cal Rx (DHCS)",
          "slug": "MEDICALRX-CLUSTER",
          "id": "CA-MCD-MEDICALRX-CLUSTER",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": null,
          "pbm": null,
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Central California Alliance for Health",
          "slug": "CCAH",
          "id": "CA-MCD-CCAH",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": null,
          "pbm": null,
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        }
      ],
      "CO": [
        {
          "name": "Aetna",
          "slug": "AETNA",
          "id": "CO-COM-AETNA",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "CVS Health",
          "pbm": "CVS Caremark",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Anthem (Elevance)",
          "slug": "ELEV",
          "id": "CO-COM-ELEV",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "Elevance Health",
          "pbm": "IngenioRx (Carelon)",
          "url": "https://www.anthem.com/provider/",
          "turnaround": "7 calendar days",
          "expedited": "72 hours",
          "goldCard": "HB 24-1149 ACTIVE - tracking approval rates",
          "channel": "Availity / Anthem Portal"
        },
        {
          "name": "Cigna",
          "slug": "CIGNA",
          "id": "CO-COM-CIGNA",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "Cigna",
          "pbm": "Express Scripts",
          "url": "https://www.cigna.com/providers/",
          "turnaround": "7 calendar days",
          "expedited": "72 hours",
          "goldCard": "HB 24-1149 ACTIVE - statutory compliance required",
          "channel": "Cigna Provider Portal"
        },
        {
          "name": "Friday Health Plans",
          "slug": "FRIDAY",
          "id": "CO-COM-FRIDAY",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "Friday Health Plans",
          "pbm": "Express Scripts",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Kaiser Permanente",
          "slug": "KAISER",
          "id": "CO-COM-KAISER",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "Kaiser Foundation Health Plan",
          "pbm": "Kaiser Permanente (Internal)/MedImpact",
          "url": "https://healthy.kaiserpermanente.org/colorado/",
          "turnaround": "Internal",
          "expedited": "Internal",
          "goldCard": "Internal Protocol - exemptions rare",
          "channel": "Kaiser Internal System"
        },
        {
          "name": "UnitedHealthcare",
          "slug": "UHC",
          "id": "CO-COM-UHC",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "UnitedHealth Group",
          "pbm": "OptumRx",
          "url": "https://www.uhcprovider.com/",
          "turnaround": "7 calendar days",
          "expedited": "72 hours",
          "goldCard": "⚠️ HB 24-1149 ACTIVE - 90% threshold (exceeds statutory 80%)",
          "channel": "UHC Provider Portal"
        },
        {
          "name": "Colorado Access",
          "slug": "COACCESS",
          "id": "CO-MCD-COACCESS",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "Colorado Access",
          "pbm": "Express Scripts",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Denver Health Medical Plan",
          "slug": "DENVERHEALTH",
          "id": "CO-MCD-DENVERHEALTH",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "Denver Health",
          "pbm": "Express Scripts",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Friday Health Plans",
          "slug": "FRIDAY",
          "id": "CO-MCD-FRIDAY",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "Friday Health Plans",
          "pbm": "Express Scripts",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Health First Colorado (Kaiser)",
          "slug": "KAISER",
          "id": "CO-MCD-KAISER",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "Kaiser Permanente",
          "pbm": "Kaiser Permanente (Internal)",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Rocky Mountain Health Plans",
          "slug": "ROCKYMT",
          "id": "CO-MCD-ROCKYMT",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "UnitedHealth Group",
          "pbm": "OptumRx",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Aetna Medicare",
          "slug": "AETNACARE",
          "id": "CO-MA-AETNACARE",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "CVS Health",
          "pbm": "CVS Caremark",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Anthem (Elevance)",
          "slug": "ELEV",
          "id": "CO-MA-ELEV",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "Elevance Health",
          "pbm": "IngenioRx (Carelon)",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Humana",
          "slug": "HUMANA",
          "id": "CO-MA-HUMANA",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "Humana Inc.",
          "pbm": "Humana Pharmacy Solutions",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Kaiser Permanente",
          "slug": "KAISER",
          "id": "CO-MA-KAISER",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "Kaiser Foundation Health Plan",
          "pbm": "Kaiser Permanente (Internal)/MedImpact",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "UnitedHealthcare",
          "slug": "UHC",
          "id": "CO-MA-UHC",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "UnitedHealth Group",
          "pbm": "OptumRx",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Health First Colorado (Medicaid)",
          "slug": "health-first-colorado",
          "id": "CO-MCD-HEALTHFIRST",
          "lob": "Medicaid Unified",
          "lobCode": "MCD",
          "parent": "CO Dept of Health Care Policy & Financing",
          "pbm": "Conduent",
          "url": "https://hcpf.colorado.gov/",
          "turnaround": "7 calendar days",
          "expedited": "72 hours",
          "goldCard": "N/A - Medicaid (FFS exemptions vary)",
          "channel": "HCPF Portal"
        },
        {
          "name": "Novitas Solutions (CO)",
          "slug": "novitas-jh-co",
          "id": "CO-PARTB-NOVITAS",
          "lob": "PARTB",
          "lobCode": "PARTB",
          "parent": "Novitas Solutions",
          "pbm": "N/A - Medicare",
          "url": "https://www.novitas-solutions.com/",
          "turnaround": "N/A - LCD determines",
          "expedited": null,
          "goldCard": "N/A - Federal Medicare",
          "channel": "Novitas Portal / esMD"
        },
        {
          "name": "Colorado CHP+ - Health First Colorado",
          "slug": "hfc-co-chip",
          "id": "CO-CHIP-HFC",
          "lob": "CHIP",
          "lobCode": "CHIP",
          "parent": "State of Colorado",
          "pbm": "CO HCPF",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Colorado CHP+ - Denver Health",
          "slug": "denverhealth-co-chip",
          "id": "CO-CHIP-DENVERHEALTH",
          "lob": "CHIP",
          "lobCode": "CHIP",
          "parent": "Denver Health",
          "pbm": "DH PBM",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Colorado CHP+ - Kaiser Permanente",
          "slug": "kaiser-co-chip",
          "id": "CO-CHIP-KAISER",
          "lob": "CHIP",
          "lobCode": "CHIP",
          "parent": "Kaiser Permanente",
          "pbm": "Kaiser PBM",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Noridian Healthcare Solutions (CO)",
          "slug": "NORIDIAN",
          "id": "CO-MAC-NORIDIAN",
          "lob": "Medicare MAC",
          "lobCode": "MAC",
          "parent": "Noridian",
          "pbm": "N/A - Medical Benefit",
          "url": "https://med.noridianmedicare.com/",
          "turnaround": "N/A - Post-service",
          "expedited": "N/A - Post-service",
          "goldCard": "N/A - Federal Medicare",
          "channel": "Claims-based / LCD compliance"
        },
        {
          "name": "Novitas Solutions (CO)",
          "slug": "NOVITAS",
          "id": "CO-MAC-NOVITAS",
          "lob": "Medicare MAC",
          "lobCode": "MAC",
          "parent": "Novitas",
          "pbm": "N/A - Medical Benefit",
          "url": "https://www.novitas-solutions.com/",
          "turnaround": "N/A - Post-service",
          "expedited": "N/A - Post-service",
          "goldCard": "N/A - Federal Medicare",
          "channel": "Claims-based / LCD compliance"
        },
        {
          "name": "COMEDICAID",
          "slug": null,
          "id": "CO-MCD-COMEDICAID",
          "lob": "MCD",
          "lobCode": null,
          "parent": null,
          "pbm": null,
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Multiple",
          "slug": "VARIOUS",
          "id": "CO-COM-VARIOUS",
          "lob": "COM",
          "lobCode": "COM",
          "parent": null,
          "pbm": null,
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Colorado Medicaid",
          "slug": "COMEDICAID-CLUSTER",
          "id": "CO-MCD-COMEDICAID-CLUSTER",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": null,
          "pbm": null,
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Colorado Access Choice",
          "slug": "COACCESS",
          "id": "CO-ACA-COACCESS",
          "lob": "ACA",
          "lobCode": "ACA",
          "parent": "Colorado Access",
          "pbm": null,
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        }
      ],
      "CT": [
        {
          "name": "Aetna",
          "slug": "AETNA",
          "id": "CT-COM-AETNA",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "CVS Health",
          "pbm": "CVS Caremark",
          "url": "https://www.aetna.com/",
          "turnaround": "Standard",
          "expedited": "Expedited",
          "goldCard": null,
          "channel": "Aetna Portal"
        },
        {
          "name": "Cigna",
          "slug": "CIGNA",
          "id": "CT-COM-CIGNA",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "Cigna",
          "pbm": "Express Scripts",
          "url": "https://www.cigna.com/",
          "turnaround": "Standard",
          "expedited": "Expedited",
          "goldCard": null,
          "channel": "Cigna Portal"
        },
        {
          "name": "ConnectiCare",
          "slug": "CTCARE",
          "id": "CT-COM-CTCARE",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "EmblemHealth",
          "pbm": "Express Scripts",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Elevance Health (Anthem)",
          "slug": "ELEV",
          "id": "CT-COM-ELEV",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "Elevance Health",
          "pbm": "IngenioRx (Carelon)",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "UnitedHealthcare",
          "slug": "UHC",
          "id": "CT-COM-UHC",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "UnitedHealth Group",
          "pbm": "OptumRx",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Aetna Medicare",
          "slug": "AETNACARE",
          "id": "CT-MA-AETNACARE",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "CVS Health",
          "pbm": "CVS Caremark",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Anthem (Elevance)",
          "slug": "ELEV",
          "id": "CT-MA-ELEV",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "Elevance Health",
          "pbm": "IngenioRx (Carelon)",
          "url": null,
          "turnaround": null,
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          "goldCard": null,
          "channel": null
        },
        {
          "name": "Cigna HealthSpring",
          "slug": "CIGNA",
          "id": "CT-MA-CIGNA",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "Cigna",
          "pbm": "Express Scripts",
          "url": null,
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        },
        {
          "name": "Humana",
          "slug": "HUMANA",
          "id": "CT-MA-HUMANA",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "Humana Inc.",
          "pbm": "Humana Pharmacy Solutions",
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        },
        {
          "name": "UnitedHealthcare",
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          "id": "CT-MA-UHC",
          "lob": "MA",
          "lobCode": "MA",
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        },
        {
          "name": "Connecticut Medicaid (HUSKY Health)",
          "slug": "husky-ct",
          "id": "CT-MCD-HUSKY",
          "lob": "Medicaid FFS",
          "lobCode": "MCD",
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          "pbm": "Gainwell Technologies",
          "url": "https://www.ctdssmap.com/",
          "turnaround": "Standard",
          "expedited": "Expedited",
          "goldCard": "N/A - Medicaid",
          "channel": "CHNCT Portal"
        },
        {
          "name": "Anthem BCBS Connecticut",
          "slug": "anthem-ct",
          "id": "CT-COM-ANTHEM",
          "lob": "Commercial",
          "lobCode": "COM",
          "parent": "Elevance Health",
          "pbm": "Elevance PBM",
          "url": "https://www.anthem.com/",
          "turnaround": "Standard",
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          "goldCard": null,
          "channel": "Availity"
        },
        {
          "name": "ConnectiCare (Molina)",
          "slug": "connecticare-ct",
          "id": "CT-COM-CONNECTICARE",
          "lob": "Exchange/MA",
          "lobCode": "COM",
          "parent": "Molina Healthcare",
          "pbm": "Molina PBM",
          "url": "https://www.connecticare.com/",
          "turnaround": "Standard",
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          "goldCard": null,
          "channel": "Molina Portal"
        },
        {
          "name": "National Government Services (CT)",
          "slug": "ngs-jk-ct",
          "id": "CT-PARTB-NGS",
          "lob": "PARTB",
          "lobCode": "PARTB",
          "parent": "NGS",
          "pbm": null,
          "url": "https://www.ngsmedicare.com/",
          "turnaround": "LCD",
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          "goldCard": "N/A - Federal",
          "channel": "NGS Portal"
        },
        {
          "name": "Connecticut HUSKY Health - Community Health Network",
          "slug": "chn-ct-chip",
          "id": "CT-CHIP-CHN",
          "lob": "CHIP",
          "lobCode": "CHIP",
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          "pbm": "CHN PBM",
          "url": null,
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          "goldCard": null,
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        },
        {
          "name": "Connecticut HUSKY Health - Anthem",
          "slug": "anthem-ct-chip",
          "id": "CT-CHIP-ANTHEM",
          "lob": "CHIP",
          "lobCode": "CHIP",
          "parent": "Elevance Health",
          "pbm": "Elevance PBM",
          "url": null,
          "turnaround": null,
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          "goldCard": null,
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        },
        {
          "name": "National Government Services (CT)",
          "slug": "NGS",
          "id": "CT-MAC-NGS",
          "lob": "Medicare MAC",
          "lobCode": "MAC",
          "parent": "NGS",
          "pbm": "N/A - Medical Benefit",
          "url": "https://www.ngsmedicare.com/",
          "turnaround": "N/A - Post-service",
          "expedited": "N/A - Post-service",
          "goldCard": "N/A - Federal Medicare",
          "channel": "Claims-based / LCD compliance"
        },
        {
          "name": "CT Exchange Plans",
          "slug": "EXCHANGE",
          "id": "CT-ACA-EXCHANGE",
          "lob": "ACA",
          "lobCode": "ACA",
          "parent": null,
          "pbm": null,
          "url": null,
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          "goldCard": null,
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        }
      ],
      "DE": [
        {
          "name": "Aetna",
          "slug": "AETNA",
          "id": "DE-COM-AETNA",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "CVS Health",
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        },
        {
          "name": "Cigna",
          "slug": "CIGNA",
          "id": "DE-COM-CIGNA",
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          "lobCode": "COM",
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          "url": null,
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        {
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        },
        {
          "name": "Highmark Blue Cross Blue Shield",
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          "id": "DE-COM-HIGHBCBS",
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        },
        {
          "name": "UnitedHealthcare",
          "slug": "UHC",
          "id": "DE-COM-UHC",
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          "url": null,
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        },
        {
          "name": "AmeriHealth Caritas Delaware",
          "slug": "AMERIHEALTH",
          "id": "DE-MCD-AMERIHEALTH",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "AmeriHealth Caritas",
          "pbm": "CVS Caremark",
          "url": "https://www.amerihealthcaritasde.com/",
          "turnaround": "2 business days",
          "expedited": "24 hours",
          "goldCard": "N/A - Medicaid",
          "channel": "CoverMyMeds/NaviNet"
        },
        {
          "name": "Highmark Health Options",
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          "lobCode": "MCD",
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          "url": null,
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        },
        {
          "name": "Aetna Medicare",
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        {
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        },
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        },
        {
          "name": "UnitedHealthcare",
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        },
        {
          "name": "Highmark BCBS Delaware",
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          "pbm": "Highmark PBM",
          "url": "https://www.highmarkbcbs.com/",
          "turnaround": "2 business days (18 Del C § 3381)",
          "expedited": "24 hours",
          "goldCard": "✓ Voluntary 90% (30+ procedures); Statutory Jan 2027",
          "channel": "Availity"
        },
        {
          "name": "Delaware First Health (Centene)",
          "slug": "delaware-first",
          "id": "DE-MCD-DEFIRST",
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          "lobCode": "MCD",
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          "pbm": "Centene PBM",
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        },
        {
          "name": "Novitas Solutions (DE)",
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          "url": "https://www.novitas-solutions.com/",
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        },
        {
          "name": "Delaware CHIP - Highmark",
          "slug": "highmark-de-chip",
          "id": "DE-CHIP-HIGHMARK",
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          "url": null,
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        },
        {
          "name": "Delaware CHIP - AmeriHealth Caritas",
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        },
        {
          "name": "Novitas Solutions (DE)",
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        },
        {
          "name": "Delaware First Health",
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          "lobCode": "MCD",
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          "url": "https://www.delawarefirsthealth.com/",
          "turnaround": "7 days",
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          "channel": "State Medicaid Portal"
        },
        {
          "name": "Highmark BCBS DE",
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          "url": null,
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        },
        {
          "name": "Delaware First Health (Centene)",
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        },
        {
          "name": "Ambetter Health of Delaware",
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          "lobCode": "ACA",
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          "url": null,
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          "goldCard": null,
          "channel": null
        },
        {
          "name": "Wellcare by Delaware First Health",
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          "lobCode": "MA",
          "parent": "Centene",
          "pbm": null,
          "url": null,
          "turnaround": null,
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          "channel": null
        }
      ],
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        {
          "name": "Aetna",
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          "channel": null
        },
        {
          "name": "CareFirst BlueCross BlueShield",
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        },
        {
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        },
        {
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        },
        {
          "name": "UnitedHealthcare",
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        },
        {
          "name": "Amerigroup DC",
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          "parent": "Elevance Health",
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        },
        {
          "name": "AmeriHealth Caritas DC",
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        },
        {
          "name": "CareFirst Community Health Plan DC",
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        },
        {
          "name": "MedStar Family Choice",
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          "channel": null
        },
        {
          "name": "Trusted Health Plan",
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        },
        {
          "name": "UnitedHealthcare Community Plan DC",
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          "lobCode": "MCD",
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        },
        {
          "name": "Aetna Medicare",
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        },
        {
          "name": "CareFirst BlueCross BlueShield",
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        },
        {
          "name": "Humana",
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          "url": null,
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          "channel": null
        },
        {
          "name": "UnitedHealthcare",
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          "parent": "UnitedHealth Group",
          "pbm": "OptumRx",
          "url": null,
          "turnaround": null,
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          "channel": null
        },
        {
          "name": "Kaiser Permanente Medicare Advantage",
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          "channel": null
        }
      ],
      "FL": [
        {
          "name": "Aetna",
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          "lobCode": "COM",
          "parent": "CVS Health",
          "pbm": "CVS Caremark",
          "url": "https://www.aetna.com/health-care-professionals.html",
          "turnaround": "7 calendar days",
          "expedited": "72 hours",
          "goldCard": "Yes (SB 7016) - Active",
          "channel": "Availity / Aetna Provider Portal"
        },
        {
          "name": "Ambetter (Celtic)",
          "slug": "AMBET",
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          "lobCode": "COM",
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          "pbm": "Express Scripts",
          "url": "https://ambetter.sunshinehealth.com/providers/",
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          "goldCard": "Yes (SB 7016) - Active",
          "channel": "Ambetter Provider Portal"
        },
        {
          "name": "Cigna",
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        },
        {
          "name": "Florida Blue",
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          "lobCode": "COM",
          "parent": "GuideWell Mutual",
          "pbm": "Prime Therapeutics",
          "url": "https://www.floridablue.com/providers/",
          "turnaround": "7 calendar days",
          "expedited": "72 hours",
          "goldCard": "Yes (SB 7016) - >90% approval in 2025 = exempt 2026; retrospective audit risk",
          "channel": "Availity / Florida Blue Provider Portal"
        },
        {
          "name": "Humana",
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          "lob": "COM",
          "lobCode": "COM",
          "parent": "Humana Inc.",
          "pbm": "Humana Pharmacy Solutions",
          "url": "https://www.humana.com/provider/",
          "turnaround": "7 calendar days",
          "expedited": "72 hours",
          "goldCard": "Yes (SB 7016) - Active",
          "channel": "Availity / Humana Provider Portal"
        },
        {
          "name": "UnitedHealthcare",
          "slug": "UHC",
          "id": "FL-COM-UHC",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "UnitedHealth Group",
          "pbm": "OptumRx",
          "url": "https://www.uhcprovider.com/",
          "turnaround": "7 calendar days",
          "expedited": "72 hours",
          "goldCard": "Yes (SB 7016) - Internal Gold Card + FL state mandate",
          "channel": "UHC Provider Portal / Link"
        },
        {
          "name": "Community Care Plan",
          "slug": "COMMCARE",
          "id": "FL-MCD-COMMCARE",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "Memorial Healthcare System",
          "pbm": "CVS Caremark",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Florida Community Care",
          "slug": "FLCOMMCARE",
          "id": "FL-MCD-FLCOMMCARE",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "Florida Community Care",
          "pbm": "CVS Caremark",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Humana Healthy Horizons",
          "slug": "HUMANA",
          "id": "FL-MCD-HUMANA",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "Humana",
          "pbm": "Humana Pharmacy Solutions",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Prestige Health Choice",
          "slug": "PRESTIGE",
          "id": "FL-MCD-PRESTIGE",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "Prestige Health Choice",
          "pbm": "Express Scripts",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Simply Healthcare",
          "slug": "SIMPLYHEALTH",
          "id": "FL-MCD-SIMPLYHEALTH",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "Elevance Health",
          "pbm": "IngenioRx (Carelon)",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Sunshine Health",
          "slug": "SUNSHINE",
          "id": "FL-MCD-SUNSHINE",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "Centene",
          "pbm": "Envolve Pharmacy Solutions",
          "url": "https://www.sunshinehealth.com/providers/",
          "turnaround": "7 calendar days",
          "expedited": "72 hours",
          "goldCard": "Yes (SB 7016) - Statutorily required for Medicaid",
          "channel": "Sunshine Health Provider Portal"
        },
        {
          "name": "Aetna Medicare",
          "slug": "AETNACARE",
          "id": "FL-MA-AETNACARE",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "CVS Health",
          "pbm": "CVS Caremark",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Cigna HealthSpring",
          "slug": "CIGNA",
          "id": "FL-MA-CIGNA",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "Cigna",
          "pbm": "Express Scripts",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Clover Health",
          "slug": "CLOVER",
          "id": "FL-MA-CLOVER",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "Clover Health",
          "pbm": "Express Scripts",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Devoted Health",
          "slug": "DEVOTED",
          "id": "FL-MA-DEVOTED",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "Devoted Health",
          "pbm": "Express Scripts",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Humana",
          "slug": "HUMANA",
          "id": "FL-MA-HUMANA",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "Humana Inc.",
          "pbm": "Humana Pharmacy Solutions",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "UnitedHealthcare",
          "slug": "UHC",
          "id": "FL-MA-UHC",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "UnitedHealth Group",
          "pbm": "OptumRx",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "First Coast Service Options (FCSO)",
          "slug": "fcso-mac-jn",
          "id": "FL-PARTB-FCSO",
          "lob": "PARTB",
          "lobCode": "PARTB",
          "parent": "Anthem/Elevance (parent)",
          "pbm": "N/A - Medicare",
          "url": "https://medicare.fcso.com/",
          "turnaround": "N/A - LCD determines",
          "expedited": "N/A - LCD determines",
          "goldCard": "N/A - Federal Medicare (preempts state SB 7016)",
          "channel": "FCSO Medicare Portal"
        },
        {
          "name": "Florida KidCare/MediKids - Sunshine Health",
          "slug": "sunshine-fl-chip",
          "id": "FL-CHIP-SUNSHINE",
          "lob": "CHIP",
          "lobCode": "CHIP",
          "parent": "Centene",
          "pbm": "Centene PBM",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Florida KidCare/MediKids - Molina",
          "slug": "molina-fl-chip",
          "id": "FL-CHIP-MOLINA",
          "lob": "CHIP",
          "lobCode": "CHIP",
          "parent": "Molina Healthcare",
          "pbm": "CVS Caremark",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Florida KidCare/MediKids - Simply Healthcare",
          "slug": "simply-fl-chip",
          "id": "FL-CHIP-SIMPLY",
          "lob": "CHIP",
          "lobCode": "CHIP",
          "parent": "Anthem/Elevance",
          "pbm": "Elevance PBM",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Florida KidCare/MediKids - Aetna Better Health",
          "slug": "aetna-fl-chip",
          "id": "FL-CHIP-AETNA",
          "lob": "CHIP",
          "lobCode": "CHIP",
          "parent": "CVS Health",
          "pbm": "CVS Caremark",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Florida KidCare/MediKids - Humana",
          "slug": "humana-fl-chip",
          "id": "FL-CHIP-HUMANA",
          "lob": "CHIP",
          "lobCode": "CHIP",
          "parent": "Humana",
          "pbm": "Humana PBM",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "First Coast Service Options (FL)",
          "slug": "FCSO",
          "id": "FL-MAC-FCSO",
          "lob": "Medicare MAC",
          "lobCode": "MAC",
          "parent": "First Coast",
          "pbm": "N/A - Medical Benefit",
          "url": "https://medicare.fcso.com/",
          "turnaround": "N/A - Post-service",
          "expedited": "N/A - Post-service",
          "goldCard": "N/A - Federal Medicare",
          "channel": "Claims-based / LCD compliance"
        },
        {
          "name": "FLMEDICAID",
          "slug": null,
          "id": "FL-MCD-FLMEDICAID",
          "lob": "MCD",
          "lobCode": null,
          "parent": null,
          "pbm": null,
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Florida Blue",
          "slug": "FLBLUE",
          "id": "FL-COM-FLBLUE",
          "lob": "COM",
          "lobCode": "COM",
          "parent": null,
          "pbm": null,
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Multiple",
          "slug": "VARIOUS",
          "id": "FL-COM-VARIOUS",
          "lob": "COM",
          "lobCode": "COM",
          "parent": null,
          "pbm": null,
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Florida Medicaid (Statewide)",
          "slug": "FLMEDICAID-CLUSTER",
          "id": "FL-MCD-FLMEDICAID-CLUSTER",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": null,
          "pbm": null,
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        }
      ],
      "GA": [
        {
          "name": "Aetna",
          "slug": "AETNA",
          "id": "GA-COM-AETNA",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "CVS Health",
          "pbm": "CVS Caremark",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Ambetter",
          "slug": "AMBET",
          "id": "GA-COM-AMBET",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "Centene",
          "pbm": "Express Scripts",
          "url": "https://www.ambetter.pshpgeorgia.com/",
          "turnaround": "7 calendar days",
          "expedited": "72 hours",
          "goldCard": "SB 5 Applies - July 1 2026",
          "channel": "CoverMyMeds / Ambetter Portal"
        },
        {
          "name": "Cigna",
          "slug": "CIGNA",
          "id": "GA-COM-CIGNA",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "Cigna",
          "pbm": "Express Scripts",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Elevance Health (Anthem)",
          "slug": "ELEV",
          "id": "GA-COM-ELEV",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "Elevance Health",
          "pbm": "IngenioRx (Carelon)",
          "url": "https://www.anthem.com/provider/",
          "turnaround": "7 calendar days",
          "expedited": "72 hours",
          "goldCard": "SB 5 Applies - Implementation Jan 1 2026; full compliance July 1 2026; 90% threshold",
          "channel": "Availity / CarelonRx Portal"
        },
        {
          "name": "Kaiser Permanente",
          "slug": "KAISER",
          "id": "GA-COM-KAISER",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "Kaiser Foundation Health Plan",
          "pbm": "Kaiser Permanente (Internal)/MedImpact",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "UnitedHealthcare",
          "slug": "UHC",
          "id": "GA-COM-UHC",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "UnitedHealth Group",
          "pbm": "OptumRx",
          "url": "https://www.uhcprovider.com/",
          "turnaround": "7 calendar days",
          "expedited": "72 hours",
          "goldCard": "UHC National Gold Card ACTIVE - 92% threshold on ≥10 PAs for 2 consecutive years; Advance Notification replaces PA",
          "channel": "UHC Provider Portal"
        },
        {
          "name": "Amerigroup Georgia",
          "slug": "AMERIGROUP",
          "id": "GA-MCD-AMERIGROUP",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "Elevance Health",
          "pbm": "IngenioRx (Carelon)",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "CareSource Georgia",
          "slug": "CARESOURCE",
          "id": "GA-MCD-CARESOURCE",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "CareSource",
          "pbm": "Express Scripts",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Peach State Health Plan",
          "slug": "PEACHSTATE",
          "id": "GA-MCD-PEACHSTATE",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "Centene",
          "pbm": "Envolve Pharmacy Solutions",
          "url": "https://www.pshpgeorgia.com/providers/",
          "turnaround": "7 calendar days",
          "expedited": "72 hours",
          "goldCard": "SB 5 Applies - July 1 2026",
          "channel": "CoverMyMeds / Centene Portal"
        },
        {
          "name": "WellCare of Georgia",
          "slug": "WELLCARE",
          "id": "GA-MCD-WELLCARE",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "Centene",
          "pbm": "Envolve Pharmacy Solutions",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Aetna Medicare",
          "slug": "AETNACARE",
          "id": "GA-MA-AETNACARE",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "CVS Health",
          "pbm": "CVS Caremark",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Anthem (Elevance)",
          "slug": "ELEV",
          "id": "GA-MA-ELEV",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "Elevance Health",
          "pbm": "IngenioRx (Carelon)",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Cigna HealthSpring",
          "slug": "CIGNA",
          "id": "GA-MA-CIGNA",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "Cigna",
          "pbm": "Express Scripts",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Humana",
          "slug": "HUMANA",
          "id": "GA-MA-HUMANA",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "Humana Inc.",
          "pbm": "Humana Pharmacy Solutions",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "UnitedHealthcare",
          "slug": "UHC",
          "id": "GA-MA-UHC",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "UnitedHealth Group",
          "pbm": "OptumRx",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Georgia Medicaid (DCH)",
          "slug": "georgia-medicaid-dch",
          "id": "GA-MCD-DCH",
          "lob": "Medicaid FFS/Unified PDL",
          "lobCode": "MCD",
          "parent": "GA Dept of Community Health",
          "pbm": "OptumRx (Administrative)",
          "url": "https://medicaid.georgia.gov/",
          "turnaround": "7 calendar days",
          "expedited": "72 hours",
          "goldCard": "SB 5 Applies to CMOs - July 1 2026",
          "channel": "GAMMIS / CoverMyMeds"
        },
        {
          "name": "Palmetto GBA",
          "slug": "palmetto-gba-jj",
          "id": "GA-PARTB-PALMETTO",
          "lob": "PARTB",
          "lobCode": "PARTB",
          "parent": "Palmetto GBA",
          "pbm": "N/A - Medicare",
          "url": "https://www.palmettogba.com/",
          "turnaround": "N/A - LCD determines",
          "expedited": "N/A - LCD determines",
          "goldCard": "N/A - Federal Medicare (SB 5 does not apply)",
          "channel": "Palmetto eServices"
        },
        {
          "name": "Georgia PeachCare for Kids - Peach State",
          "slug": "peachstate-ga-chip",
          "id": "GA-CHIP-PEACHSTATE",
          "lob": "CHIP",
          "lobCode": "CHIP",
          "parent": "Centene",
          "pbm": "Centene PBM",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Georgia PeachCare for Kids - CareSource",
          "slug": "caresource-ga-chip",
          "id": "GA-CHIP-CARESOURCE",
          "lob": "CHIP",
          "lobCode": "CHIP",
          "parent": "CareSource",
          "pbm": "CareSource PBM",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Georgia PeachCare for Kids - Amerigroup",
          "slug": "amerigroup-ga-chip",
          "id": "GA-CHIP-AMERIGROUP",
          "lob": "CHIP",
          "lobCode": "CHIP",
          "parent": "Elevance Health",
          "pbm": "Elevance PBM",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Palmetto GBA (GA)",
          "slug": "PALMETTO",
          "id": "GA-MAC-PALMETTO",
          "lob": "Medicare MAC",
          "lobCode": "MAC",
          "parent": "Palmetto GBA",
          "pbm": "N/A - Medical Benefit",
          "url": "https://www.palmettogba.com/",
          "turnaround": "N/A - Post-service",
          "expedited": "N/A - Post-service",
          "goldCard": "N/A - Federal Medicare",
          "channel": "Claims-based / LCD compliance"
        },
        {
          "name": "Multiple (Anthem/UHC)",
          "slug": "VARIOUS",
          "id": "GA-COM-VARIOUS",
          "lob": "COM",
          "lobCode": "COM",
          "parent": null,
          "pbm": null,
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Georgia Medicaid (Amerigroup)",
          "slug": "AMERIGRP",
          "id": "GA-MCD-AMERIGRP",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": null,
          "pbm": null,
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        }
      ],
      "IL": [
        {
          "name": "Aetna",
          "slug": "AETNA",
          "id": "IL-COM-AETNA",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "CVS Health",
          "pbm": "CVS Caremark",
          "url": "https://www.aetna.com/health-care-professionals.html",
          "turnaround": "7 calendar days",
          "expedited": "72 hours",
          "goldCard": "Public Act 103-0593 - July 1 2026",
          "channel": "Availity / Aetna Provider Portal"
        },
        {
          "name": "Cigna",
          "slug": "CIGNA",
          "id": "IL-COM-CIGNA",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "Cigna",
          "pbm": "Express Scripts",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Health Care Service Corp. (BCBSIL)",
          "slug": "BCBSIL",
          "id": "IL-COM-BCBSIL",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "HCSC",
          "pbm": "Prime Therapeutics",
          "url": "https://www.bcbsil.com/provider/",
          "turnaround": "7 calendar days",
          "expedited": "72 hours",
          "goldCard": "Public Act 103-0593 - DELAYED to July 1 2026; 90% threshold on ≥50 PAs in 12 months preceding",
          "channel": "Availity / Carelon Portal"
        },
        {
          "name": "Humana",
          "slug": "HUMANA",
          "id": "IL-COM-HUMANA",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "Humana Inc.",
          "pbm": "Humana Pharmacy Solutions",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "UnitedHealthcare",
          "slug": "UHC",
          "id": "IL-COM-UHC",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "UnitedHealth Group",
          "pbm": "OptumRx",
          "url": "https://www.uhcprovider.com/",
          "turnaround": "7 calendar days",
          "expedited": "72 hours",
          "goldCard": "Public Act 103-0593 - July 1 2026",
          "channel": "UHC Provider Portal / Link"
        },
        {
          "name": "Aetna Better Health of Illinois",
          "slug": "AETNABETTER",
          "id": "IL-MCD-AETNABETTER",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "CVS Health",
          "pbm": "CVS Caremark",
          "url": "https://www.aetnabetterhealth.com/illinois/providers/",
          "turnaround": "7 calendar days",
          "expedited": "72 hours",
          "goldCard": "Public Act 103-0593 - July 1 2026",
          "channel": "Aetna Better Health Provider Portal"
        },
        {
          "name": "Blue Cross Blue Shield of Illinois",
          "slug": "ILBCBS",
          "id": "IL-MCD-ILBCBS",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "HCSC",
          "pbm": "Prime Therapeutics",
          "url": "https://www.bcbsil.com/provider/bcchp/",
          "turnaround": "7 calendar days",
          "expedited": "72 hours",
          "goldCard": "Public Act 103-0593 - July 1 2026",
          "channel": "BCCHP Provider Portal"
        },
        {
          "name": "CountyCare Health Plan",
          "slug": "COUNTYCARE",
          "id": "IL-MCD-COUNTYCARE",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "Cook County Health",
          "pbm": "Express Scripts",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Meridian Health Plan of Illinois",
          "slug": "MERIDIAN",
          "id": "IL-MCD-MERIDIAN",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "Centene",
          "pbm": "Envolve Pharmacy Solutions",
          "url": "https://www.mymhp.com/providers/",
          "turnaround": "7 calendar days",
          "expedited": "72 hours",
          "goldCard": "Public Act 103-0593 - July 1 2026",
          "channel": "Meridian Provider Portal"
        },
        {
          "name": "Molina Healthcare of Illinois",
          "slug": "MOLINA",
          "id": "IL-MCD-MOLINA",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "Molina Healthcare",
          "pbm": "CVS Caremark",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "YouthCare",
          "slug": "YOUTHCARE",
          "id": "IL-MCD-YOUTHCARE",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "YouthCare",
          "pbm": "Express Scripts",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Aetna Medicare",
          "slug": "AETNACARE",
          "id": "IL-MA-AETNACARE",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "CVS Health",
          "pbm": "CVS Caremark",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Blue Cross Blue Shield of Illinois",
          "slug": "ILBCBS",
          "id": "IL-MA-ILBCBS",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "HCSC",
          "pbm": "Prime Therapeutics",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Cigna HealthSpring",
          "slug": "CIGNA",
          "id": "IL-MA-CIGNA",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "Cigna",
          "pbm": "Express Scripts",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Humana",
          "slug": "HUMANA",
          "id": "IL-MA-HUMANA",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "Humana Inc.",
          "pbm": "Humana Pharmacy Solutions",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "UnitedHealthcare",
          "slug": "UHC",
          "id": "IL-MA-UHC",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "UnitedHealth Group",
          "pbm": "OptumRx",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "National Government Services (NGS)",
          "slug": "ngs-mac-j6",
          "id": "IL-PARTB-NGS",
          "lob": "PARTB",
          "lobCode": "PARTB",
          "parent": "Anthem/Elevance",
          "pbm": "N/A - Medicare",
          "url": "https://www.ngsmedicare.com/",
          "turnaround": "N/A - LCD determines",
          "expedited": "N/A - LCD determines",
          "goldCard": "N/A - Federal Medicare",
          "channel": "NGS Medicare Portal"
        },
        {
          "name": "Illinois All Kids - Molina",
          "slug": "molina-il-chip",
          "id": "IL-CHIP-MOLINA",
          "lob": "CHIP",
          "lobCode": "CHIP",
          "parent": "Molina Healthcare",
          "pbm": "CVS Caremark",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Illinois All Kids - Meridian",
          "slug": "meridian-il-chip",
          "id": "IL-CHIP-MERIDIAN",
          "lob": "CHIP",
          "lobCode": "CHIP",
          "parent": "Centene",
          "pbm": "Centene PBM",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Illinois All Kids - Blue Cross Community",
          "slug": "bcbsil-chip",
          "id": "IL-CHIP-BCBS",
          "lob": "CHIP",
          "lobCode": "CHIP",
          "parent": "HCSC",
          "pbm": "Prime Therapeutics",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Illinois All Kids - CountyCare",
          "slug": "countycare-il-chip",
          "id": "IL-CHIP-COUNTYCARE",
          "lob": "CHIP",
          "lobCode": "CHIP",
          "parent": "Cook County Health",
          "pbm": "CountyCare PBM",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "National Government Services (IL)",
          "slug": "NGS",
          "id": "IL-MAC-NGS",
          "lob": "Medicare MAC",
          "lobCode": "MAC",
          "parent": "NGS",
          "pbm": "N/A - Medical Benefit",
          "url": "https://www.ngsmedicare.com/",
          "turnaround": "N/A - Post-service",
          "expedited": "N/A - Post-service",
          "goldCard": "N/A - Federal Medicare",
          "channel": "Claims-based / LCD compliance"
        },
        {
          "name": "Illinois Medicaid (HFS)",
          "slug": "ILHFS",
          "id": "IL-MCD-ILHFS",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": null,
          "pbm": null,
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Wellcare Meridian Dual Align (HMO D-SNP)",
          "slug": "WELLCAREMERIDIAN",
          "id": "IL-MA-WELLCAREMERIDIAN",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "Centene",
          "pbm": null,
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        }
      ],
      "IN": [
        {
          "name": "Aetna",
          "slug": "AETNA",
          "id": "IN-COM-AETNA",
          "lob": "COM",
          "lobCode": "COM",
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          "url": null,
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          "goldCard": null,
          "channel": null
        },
        {
          "name": "Cigna",
          "slug": "CIGNA",
          "id": "IN-COM-CIGNA",
          "lob": "COM",
          "lobCode": "COM",
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          "pbm": "Express Scripts",
          "url": null,
          "turnaround": null,
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          "goldCard": null,
          "channel": null
        },
        {
          "name": "Elevance Health (Anthem)",
          "slug": "ELEV",
          "id": "IN-COM-ELEV",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "Elevance Health",
          "pbm": "IngenioRx (Carelon)",
          "url": null,
          "turnaround": null,
          "expedited": null,
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          "channel": null
        },
        {
          "name": "Physicians Health Plan",
          "slug": "PHYSHEALTH",
          "id": "IN-COM-PHYSHEALTH",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "PHP",
          "pbm": "Express Scripts",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "UnitedHealthcare",
          "slug": "UHC",
          "id": "IN-COM-UHC",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "UnitedHealth Group",
          "pbm": "OptumRx",
          "url": "https://www.uhcprovider.com/",
          "turnaround": "48 hours (SB 480)",
          "expedited": "24 hours",
          "goldCard": "✓ National Gold Card (92%)",
          "channel": "Optum Pro Portal"
        },
        {
          "name": "Anthem Blue Cross Blue Shield (Indiana)",
          "slug": "ANTHEM",
          "id": "IN-MCD-ANTHEM",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "Elevance Health",
          "pbm": "IngenioRx (Carelon)",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "CareSource Indiana",
          "slug": "CARESOURCE",
          "id": "IN-MCD-CARESOURCE",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "CareSource",
          "pbm": "Express Scripts",
          "url": "https://www.caresource.com/",
          "turnaround": "Standard",
          "expedited": "Expedited",
          "goldCard": "N/A - Medicaid",
          "channel": "CareSource Portal"
        },
        {
          "name": "Managed Health Services (MHS)",
          "slug": "MANAGEDHEALTH",
          "id": "IN-MCD-MANAGEDHEALTH",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "Centene",
          "pbm": "Envolve Pharmacy Solutions",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "MDwise",
          "slug": "MDWISE",
          "id": "IN-MCD-MDWISE",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "MDwise",
          "pbm": "Express Scripts",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "UnitedHealthcare Community Plan Indiana",
          "slug": "UHC",
          "id": "IN-MCD-UHC",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "UnitedHealth Group",
          "pbm": "OptumRx",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Aetna Medicare",
          "slug": "AETNACARE",
          "id": "IN-MA-AETNACARE",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "CVS Health",
          "pbm": "CVS Caremark",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Anthem (Elevance)",
          "slug": "ELEV",
          "id": "IN-MA-ELEV",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "Elevance Health",
          "pbm": "IngenioRx (Carelon)",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Cigna HealthSpring",
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          "id": "IN-MA-CIGNA",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "Cigna",
          "pbm": "Express Scripts",
          "url": null,
          "turnaround": null,
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          "goldCard": null,
          "channel": null
        },
        {
          "name": "Humana",
          "slug": "HUMANA",
          "id": "IN-MA-HUMANA",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "Humana Inc.",
          "pbm": "Humana Pharmacy Solutions",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "UnitedHealthcare",
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          "id": "IN-MA-UHC",
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          "lobCode": "MA",
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          "url": null,
          "turnaround": null,
          "expedited": null,
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          "channel": null
        },
        {
          "name": "Indiana Medicaid (IHCP/SUPDL)",
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          "lob": "Medicaid FFS",
          "lobCode": "MCD",
          "parent": "Indiana FSSA",
          "pbm": "IHCP PBM",
          "url": "https://www.in.gov/medicaid/",
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          "goldCard": "N/A - Medicaid",
          "channel": "IHCP Portal"
        },
        {
          "name": "Anthem Indiana",
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          "lobCode": "COM",
          "parent": "Elevance Health",
          "pbm": "Carelon",
          "url": "https://www.anthem.com/",
          "turnaround": "Standard",
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          "goldCard": null,
          "channel": "Availity"
        },
        {
          "name": "MHS Indiana",
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          "lobCode": "MCD",
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          "pbm": "Centene PBM",
          "url": "https://www.mhsindiana.com/",
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          "channel": "MHS Portal"
        },
        {
          "name": "WPS GHA (IN)",
          "slug": "wps-j5-in",
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          "lob": "PARTB",
          "lobCode": "PARTB",
          "parent": "WPS Government Health Administrators",
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          "url": "https://www.wpsgha.com/",
          "turnaround": "LCD",
          "expedited": null,
          "goldCard": "N/A - Federal",
          "channel": "WPS Portal"
        },
        {
          "name": "Indiana Hoosier Healthwise CHIP - Anthem",
          "slug": "anthem-in-chip",
          "id": "IN-CHIP-ANTHEM",
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          "lobCode": "CHIP",
          "parent": "Elevance Health",
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          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Indiana Hoosier Healthwise CHIP - CareSource",
          "slug": "caresource-in-chip",
          "id": "IN-CHIP-CARESOURCE",
          "lob": "CHIP",
          "lobCode": "CHIP",
          "parent": "CareSource",
          "pbm": "CareSource PBM",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Indiana Hoosier Healthwise CHIP - Managed Health Services",
          "slug": "mhs-in-chip",
          "id": "IN-CHIP-MHS",
          "lob": "CHIP",
          "lobCode": "CHIP",
          "parent": "Centene",
          "pbm": "Centene PBM",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "WPS Government Health Administrators (IN)",
          "slug": "WPS",
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          "lob": "Medicare MAC",
          "lobCode": "MAC",
          "parent": "WPS",
          "pbm": "N/A - Medical Benefit",
          "url": "https://www.wpsgha.com/",
          "turnaround": "N/A - Post-service",
          "expedited": "N/A - Post-service",
          "goldCard": "N/A - Federal Medicare",
          "channel": "Claims-based / LCD compliance"
        }
      ],
      "IA": [
        {
          "name": "Aetna",
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          "lobCode": "COM",
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          "url": "https://www.aetna.com/",
          "turnaround": "Standard",
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          "goldCard": null,
          "channel": "Aetna Portal"
        },
        {
          "name": "Medica",
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          "id": "IA-COM-MEDICA",
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          "lobCode": "COM",
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          "url": null,
          "turnaround": null,
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          "channel": null
        },
        {
          "name": "UnitedHealthcare",
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          "lobCode": "COM",
          "parent": "UnitedHealth Group",
          "pbm": "OptumRx",
          "url": "https://www.uhcprovider.com/",
          "turnaround": "10 days (HF 303)",
          "expedited": "48 hours",
          "goldCard": "✓ National Gold Card + HF 303 pilot",
          "channel": "Optum Pro Portal"
        },
        {
          "name": "Wellmark",
          "slug": "WELLMARK",
          "id": "IA-COM-WELLMARK",
          "lob": "COM",
          "lobCode": "COM",
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          "pbm": "CVS Caremark",
          "url": "https://www.wellmark.com/",
          "turnaround": "Standard",
          "expedited": "Expedited",
          "goldCard": "⚠️ HF 303 Gold Card pilot Jan 15 2026",
          "channel": "Wellmark Portal"
        },
        {
          "name": "Wellmark Blue Cross Blue Shield",
          "slug": "WELLBCBS",
          "id": "IA-COM-WELLBCBS",
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          "lobCode": "COM",
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          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Iowa Total Care",
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          "id": "IA-MCD-TOTALIOWA",
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          "lobCode": "MCD",
          "parent": "Centene",
          "pbm": "Envolve Pharmacy Solutions",
          "url": null,
          "turnaround": null,
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          "goldCard": null,
          "channel": null
        },
        {
          "name": "Molina Healthcare of Iowa",
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          "id": "IA-MCD-MOLINA",
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          "lobCode": "MCD",
          "parent": "Molina Healthcare",
          "pbm": "CVS Caremark",
          "url": "https://www.molinahealthcare.com/",
          "turnaround": "Standard",
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          "goldCard": "N/A - Medicaid",
          "channel": "Molina Portal"
        },
        {
          "name": "Aetna Medicare",
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          "id": "IA-MA-AETNACARE",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "CVS Health",
          "pbm": "CVS Caremark",
          "url": null,
          "turnaround": null,
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          "goldCard": null,
          "channel": null
        },
        {
          "name": "Humana",
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          "lob": "MA",
          "lobCode": "MA",
          "parent": "Humana Inc.",
          "pbm": "Humana Pharmacy Solutions",
          "url": null,
          "turnaround": null,
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          "channel": null
        },
        {
          "name": "UnitedHealthcare",
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          "parent": "UnitedHealth Group",
          "pbm": "OptumRx",
          "url": null,
          "turnaround": null,
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          "channel": null
        },
        {
          "name": "Wellmark Blue Cross Blue Shield",
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          "id": "IA-MA-WELLMARKBCBS",
          "lob": "MA",
          "lobCode": "MA",
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          "pbm": "CVS Caremark",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Iowa Total Care (Centene)",
          "slug": "iowa-total-care",
          "id": "IA-MCD-ITC",
          "lob": "Medicaid MCO",
          "lobCode": "MCD",
          "parent": "Centene",
          "pbm": "Centene PBM",
          "url": "https://www.iowatotalcare.com/",
          "turnaround": "Standard",
          "expedited": "Expedited",
          "goldCard": "N/A - Medicaid",
          "channel": "Centene Portal"
        },
        {
          "name": "Wellpoint Iowa",
          "slug": "wellpoint-ia",
          "id": "IA-MCD-WELLPOINT",
          "lob": "Medicaid MCO",
          "lobCode": "MCD",
          "parent": "Elevance Health",
          "pbm": "Elevance PBM",
          "url": "https://www.wellpoint.com/",
          "turnaround": "Standard",
          "expedited": "Expedited",
          "goldCard": "N/A - Medicaid",
          "channel": "Elevance Portal"
        },
        {
          "name": "WPS GHA (IA)",
          "slug": "wps-j5-ia",
          "id": "IA-PARTB-WPS",
          "lob": "PARTB",
          "lobCode": "PARTB",
          "parent": "WPS Government Health Administrators",
          "pbm": null,
          "url": "https://www.wpsgha.com/",
          "turnaround": "LCD",
          "expedited": null,
          "goldCard": "N/A - Federal",
          "channel": "WPS Portal"
        },
        {
          "name": "Iowa Hawki - All plans",
          "slug": "hawki-ia-chip",
          "id": "IA-CHIP-HAWKI",
          "lob": "CHIP",
          "lobCode": "CHIP",
          "parent": "State of Iowa",
          "pbm": "IA DHS",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Iowa Hawki - Amerigroup",
          "slug": "amerigroup-ia-chip",
          "id": "IA-CHIP-AMERIGROUP",
          "lob": "CHIP",
          "lobCode": "CHIP",
          "parent": "Elevance Health",
          "pbm": "Elevance PBM",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Iowa Hawki - Molina",
          "slug": "molina-ia-chip",
          "id": "IA-CHIP-MOLINA",
          "lob": "CHIP",
          "lobCode": "CHIP",
          "parent": "Molina Healthcare",
          "pbm": "CVS Caremark",
          "url": null,
          "turnaround": null,
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          "goldCard": null,
          "channel": null
        },
        {
          "name": "Iowa Medicaid FFS",
          "slug": "IAHHS",
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          "expedited": "N/A - Post-service",
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        {
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        {
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        {
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        {
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        {
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        {
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        {
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        {
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        {
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        {
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        {
          "name": "Sunflower Health Plan",
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        {
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          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "AmeriHealth Caritas",
          "pbm": "CVS Caremark",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Healthy Blue",
          "slug": "HEALTHYBLUE",
          "id": "LA-MCD-HEALTHYBLUE",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "Elevance Health",
          "pbm": "IngenioRx (Carelon)",
          "url": "https://www.healthybluela.com/",
          "turnaround": "Standard",
          "expedited": "Expedited",
          "goldCard": "N/A - Medicaid",
          "channel": "Elevance Portal"
        },
        {
          "name": "Louisiana Healthcare Connections",
          "slug": "LACONNECT",
          "id": "LA-MCD-LACONNECT",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "Centene",
          "pbm": "Envolve Pharmacy Solutions",
          "url": "https://www.louisianahealthconnect.com/",
          "turnaround": "Standard",
          "expedited": "Expedited",
          "goldCard": "N/A - Medicaid",
          "channel": "Centene Portal"
        },
        {
          "name": "UnitedHealthcare Community Plan Louisiana",
          "slug": "UHC",
          "id": "LA-MCD-UHC",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "UnitedHealth Group",
          "pbm": "OptumRx",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Aetna Medicare",
          "slug": "AETNACARE",
          "id": "LA-MA-AETNACARE",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "CVS Health",
          "pbm": "CVS Caremark",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Blue Cross Blue Shield of Louisiana",
          "slug": "LABCBS",
          "id": "LA-MA-LABCBS",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "BCBSLA",
          "pbm": "Prime Therapeutics",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Humana",
          "slug": "HUMANA",
          "id": "LA-MA-HUMANA",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "Humana Inc.",
          "pbm": "Humana Pharmacy Solutions",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "UnitedHealthcare",
          "slug": "UHC",
          "id": "LA-MA-UHC",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "UnitedHealth Group",
          "pbm": "OptumRx",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Vantage Health Plan",
          "slug": "VANTAGEHEALTH",
          "id": "LA-MA-VANTAGEHEALTH",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "Vantage Health Plan",
          "pbm": "CVS Caremark",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Blue Cross Blue Shield Louisiana",
          "slug": "bcbsla-la",
          "id": "LA-COM-BCBSLA",
          "lob": "Commercial",
          "lobCode": "COM",
          "parent": "BCBSLA",
          "pbm": "BCBSLA PBM",
          "url": "https://www.bcbsla.com/",
          "turnaround": "Standard",
          "expedited": "Expedited",
          "goldCard": "✓ Act 432 applies (medical benefit only)",
          "channel": "BCBSLA Portal"
        },
        {
          "name": "Novitas Solutions (LA)",
          "slug": "novitas-jh-la",
          "id": "LA-PARTB-NOVITAS",
          "lob": "PARTB",
          "lobCode": "PARTB",
          "parent": "Novitas Solutions",
          "pbm": null,
          "url": "https://www.novitas-solutions.com/",
          "turnaround": "LCD",
          "expedited": null,
          "goldCard": "N/A - Federal",
          "channel": "Novitas Portal"
        },
        {
          "name": "Louisiana LaCHIP - Healthy Blue",
          "slug": "healthyblue-la-chip",
          "id": "LA-CHIP-HEALTHYBLUE",
          "lob": "CHIP",
          "lobCode": "CHIP",
          "parent": "Elevance Health",
          "pbm": "Elevance PBM",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Louisiana LaCHIP - Aetna Better Health",
          "slug": "aetna-la-chip",
          "id": "LA-CHIP-AETNA",
          "lob": "CHIP",
          "lobCode": "CHIP",
          "parent": "CVS Health",
          "pbm": "CVS Caremark",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Louisiana LaCHIP - UnitedHealthcare CP",
          "slug": "uhc-la-chip",
          "id": "LA-CHIP-UHC",
          "lob": "CHIP",
          "lobCode": "CHIP",
          "parent": "UnitedHealth Group",
          "pbm": "OptumRx",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Louisiana Healthcare Connections",
          "slug": "LHC",
          "id": "LA-MCD-LHC",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "Centene",
          "pbm": "State SPBM",
          "url": "https://www.louisianahealthconnect.com/",
          "turnaround": "7 days",
          "expedited": "72 hours",
          "goldCard": "N/A - Medicaid",
          "channel": "State Medicaid Portal"
        },
        {
          "name": "Novitas Solutions (LA)",
          "slug": "NOVITAS",
          "id": "LA-MAC-NOVITAS",
          "lob": "Medicare MAC",
          "lobCode": "MAC",
          "parent": "Novitas",
          "pbm": "N/A - Medical Benefit",
          "url": "https://www.novitas-solutions.com/",
          "turnaround": "N/A - Post-service",
          "expedited": "N/A - Post-service",
          "goldCard": "N/A - Federal Medicare",
          "channel": "Claims-based / LCD compliance"
        },
        {
          "name": "Medica (VantagePlus)",
          "slug": "MEDICA",
          "id": "LA-COM-MEDICA",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "Medica",
          "pbm": null,
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        }
      ],
      "ME": [
        {
          "name": "Aetna",
          "slug": "AETNA",
          "id": "ME-COM-AETNA",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "CVS Health",
          "pbm": "CVS Caremark",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Community Health Options",
          "slug": "COMMHEALTH",
          "id": "ME-COM-COMMHEALTH",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "Maine Health Management Coalition",
          "pbm": "Express Scripts",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Elevance Health (Anthem)",
          "slug": "ELEV",
          "id": "ME-COM-ELEV",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "Elevance Health",
          "pbm": "IngenioRx (Carelon)",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Harvard Pilgrim",
          "slug": "HARVARD",
          "id": "ME-COM-HARVARD",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "Point32Health",
          "pbm": "Express Scripts",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "UnitedHealthcare",
          "slug": "UHC",
          "id": "ME-COM-UHC",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "UnitedHealth Group",
          "pbm": "OptumRx",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Aetna Medicare",
          "slug": "AETNACARE",
          "id": "ME-MA-AETNACARE",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "CVS Health",
          "pbm": "CVS Caremark",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Anthem (Elevance)",
          "slug": "ELEV",
          "id": "ME-MA-ELEV",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "Elevance Health",
          "pbm": "IngenioRx (Carelon)",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Martin's Point Health Care",
          "slug": "MARTINS",
          "id": "ME-MA-MARTINS",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "Martin's Point Health Care",
          "pbm": "Express Scripts",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "UnitedHealthcare",
          "slug": "UHC",
          "id": "ME-MA-UHC",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "UnitedHealth Group",
          "pbm": "OptumRx",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Anthem BCBS Maine",
          "slug": "anthem-me",
          "id": "ME-COM-ANTHEM",
          "lob": "Commercial",
          "lobCode": "COM",
          "parent": "Elevance Health",
          "pbm": "CarelonRx",
          "url": "https://www.anthem.com/",
          "turnaround": "Standard",
          "expedited": "Expedited",
          "goldCard": "⚠️ No mandatory Gold Card - focus on continuity",
          "channel": "Anthem Portal"
        },
        {
          "name": "MaineCare (DHHS)",
          "slug": "mainecare-me",
          "id": "ME-MCD-DHHS",
          "lob": "Medicaid FFS",
          "lobCode": "MCD",
          "parent": "Maine DHHS",
          "pbm": "Change Healthcare",
          "url": "https://www.maine.gov/dhhs/",
          "turnaround": "72 hours (PL 680)",
          "expedited": "24 hours",
          "goldCard": "N/A - Medicaid",
          "channel": "MaineCare Portal"
        },
        {
          "name": "Community Health Options (CHO)",
          "slug": "cho-me",
          "id": "ME-COM-CHO",
          "lob": "Commercial ACA CO-OP",
          "lobCode": "COM",
          "parent": "CHO",
          "pbm": "Express Scripts",
          "url": "https://www.healthoptions.org/",
          "turnaround": "Standard",
          "expedited": "Expedited",
          "goldCard": null,
          "channel": "CHO Portal"
        },
        {
          "name": "Harvard Pilgrim Maine",
          "slug": "harvardpilgrim-me",
          "id": "ME-COM-HARVARDPILGRIM",
          "lob": "Commercial",
          "lobCode": "COM",
          "parent": "Point32Health",
          "pbm": "Harvard Pilgrim PBM",
          "url": "https://www.harvardpilgrim.org/",
          "turnaround": "Standard",
          "expedited": "Expedited",
          "goldCard": null,
          "channel": "HPHC Portal"
        },
        {
          "name": "NGS (Maine)",
          "slug": "ngs-jk-me",
          "id": "ME-PARTB-NGS",
          "lob": "PARTB",
          "lobCode": "PARTB",
          "parent": "National Government Services",
          "pbm": null,
          "url": "https://www.ngsmedicare.com/",
          "turnaround": "LCD",
          "expedited": null,
          "goldCard": "N/A - Federal",
          "channel": "NGS Portal"
        },
        {
          "name": "Maine CubCare - All plans",
          "slug": "cubcare-me-chip",
          "id": "ME-CHIP-CUBCARE",
          "lob": "CHIP",
          "lobCode": "CHIP",
          "parent": "State of Maine",
          "pbm": "Change Healthcare",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "National Government Services (ME)",
          "slug": "NGS",
          "id": "ME-MAC-NGS",
          "lob": "Medicare MAC",
          "lobCode": "MAC",
          "parent": "NGS",
          "pbm": "N/A - Medical Benefit",
          "url": "https://www.ngsmedicare.com/",
          "turnaround": "N/A - Post-service",
          "expedited": "N/A - Post-service",
          "goldCard": "N/A - Federal Medicare",
          "channel": "Claims-based / LCD compliance"
        },
        {
          "name": "MaineCare FFS",
          "slug": "MAINECARE",
          "id": "ME-MCD-MAINECARE",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "ME DHHS",
          "pbm": "State SPBM",
          "url": "https://www.maine.gov/dhhs/oms/",
          "turnaround": "7 days",
          "expedited": "72 hours",
          "goldCard": "N/A - Medicaid",
          "channel": "State Medicaid Portal"
        },
        {
          "name": "Arcadian Health Plan, Inc.",
          "slug": "ARCADIAN",
          "id": "ME-MA-ARCADIAN",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "Humana",
          "pbm": null,
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Emphesys Insurance Company",
          "slug": "EMPHESYS",
          "id": "ME-MA-EMPHESYS",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "Humana",
          "pbm": null,
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        }
      ],
      "MD": [
        {
          "name": "Aetna",
          "slug": "AETNA",
          "id": "MD-COM-AETNA",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "CVS Health",
          "pbm": "CVS Caremark",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "CareFirst BlueCross BlueShield",
          "slug": "CAREFIRST",
          "id": "MD-COM-CAREFIRST",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "CareFirst Inc.",
          "pbm": "CVS Caremark",
          "url": "https://provider.carefirst.com/",
          "turnaround": "Standard",
          "expedited": "Expedited",
          "goldCard": "⚠️ Feasibility study mandated - no statute yet",
          "channel": "CareFirst Portal"
        },
        {
          "name": "Cigna",
          "slug": "CIGNA",
          "id": "MD-COM-CIGNA",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "Cigna",
          "pbm": "Express Scripts",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Kaiser Permanente",
          "slug": "KAISER",
          "id": "MD-COM-KAISER",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "Kaiser Foundation Health Plan",
          "pbm": "Kaiser Permanente (Internal)/MedImpact",
          "url": "https://healthy.kaiserpermanente.org/",
          "turnaround": "Internal",
          "expedited": "Internal",
          "goldCard": "N/A - Integrated",
          "channel": "Kaiser Internal"
        },
        {
          "name": "UnitedHealthcare",
          "slug": "UHC",
          "id": "MD-COM-UHC",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "UnitedHealth Group",
          "pbm": "OptumRx",
          "url": "https://www.uhcprovider.com/",
          "turnaround": "Standard",
          "expedited": "Expedited",
          "goldCard": "✓ National Gold Card Program (92% voluntary)",
          "channel": "Optum Pro Portal"
        },
        {
          "name": "Aetna Better Health of Maryland",
          "slug": "AETNABETTER",
          "id": "MD-MCD-AETNABETTER",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "CVS Health",
          "pbm": "CVS Caremark",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "CareFirst Community Health Plan Maryland",
          "slug": "CAREFIRST",
          "id": "MD-MCD-CAREFIRST",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "CareFirst BlueCross BlueShield",
          "pbm": "CVS Caremark",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Kaiser Permanente of Mid-Atlantic",
          "slug": "KAISER",
          "id": "MD-MCD-KAISER",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "Kaiser Permanente",
          "pbm": "Kaiser Permanente (Internal)",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Maryland Physicians Care",
          "slug": "MDPHYSICIANS",
          "id": "MD-MCD-MDPHYSICIANS",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "Maryland Physicians Care",
          "pbm": "Express Scripts",
          "url": "https://www.marylandphysicianscare.com/",
          "turnaround": "Standard",
          "expedited": "Expedited",
          "goldCard": "N/A - Medicaid",
          "channel": "MPC Portal"
        },
        {
          "name": "MedStar Family Choice",
          "slug": "MEDSTARFAMILY",
          "id": "MD-MCD-MEDSTARFAMILY",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "MedStar Health",
          "pbm": "Express Scripts",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Priority Partners",
          "slug": "PRIORITYPART",
          "id": "MD-MCD-PRIORITYPART",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "Johns Hopkins HealthCare",
          "pbm": "Express Scripts",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "UnitedHealthcare Community Plan Maryland",
          "slug": "UHC",
          "id": "MD-MCD-UHC",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "UnitedHealth Group",
          "pbm": "OptumRx",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Aetna Medicare",
          "slug": "AETNACARE",
          "id": "MD-MA-AETNACARE",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "CVS Health",
          "pbm": "CVS Caremark",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "CareFirst BlueCross BlueShield",
          "slug": "CAREBCBS",
          "id": "MD-MA-CAREBCBS",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "CareFirst Inc.",
          "pbm": "CVS Caremark",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Humana",
          "slug": "HUMANA",
          "id": "MD-MA-HUMANA",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "Humana Inc.",
          "pbm": "Humana Pharmacy Solutions",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Kaiser Permanente",
          "slug": "KAISER",
          "id": "MD-MA-KAISER",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "Kaiser Foundation Health Plan",
          "pbm": "Kaiser Permanente (Internal)/MedImpact",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "UnitedHealthcare",
          "slug": "UHC",
          "id": "MD-MA-UHC",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "UnitedHealth Group",
          "pbm": "OptumRx",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Maryland Medicaid (Priority Partners)",
          "slug": "priority-partners-md",
          "id": "MD-MCD-PRIORITY",
          "lob": "Medicaid MCO",
          "lobCode": "MCD",
          "parent": "Johns Hopkins",
          "pbm": "Priority Partners PBM",
          "url": "https://www.ppmco.org/",
          "turnaround": "Standard",
          "expedited": "Expedited",
          "goldCard": "N/A - Medicaid",
          "channel": "Priority Partners Portal"
        },
        {
          "name": "Novitas Solutions (MD)",
          "slug": "novitas-jl-md",
          "id": "MD-PARTB-NOVITAS",
          "lob": "PARTB",
          "lobCode": "PARTB",
          "parent": "Novitas Solutions",
          "pbm": null,
          "url": "https://www.novitas-solutions.com/",
          "turnaround": "LCD",
          "expedited": null,
          "goldCard": "N/A - Federal",
          "channel": "Novitas Portal"
        },
        {
          "name": "Maryland MCHP - All plans",
          "slug": "mchp-md-chip",
          "id": "MD-CHIP-MCHP",
          "lob": "CHIP",
          "lobCode": "CHIP",
          "parent": "State of Maryland",
          "pbm": "MD Medicaid",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Maryland MCHP - Kaiser",
          "slug": "kaiser-md-chip",
          "id": "MD-CHIP-KAISER",
          "lob": "CHIP",
          "lobCode": "CHIP",
          "parent": "Kaiser Permanente",
          "pbm": "Kaiser PBM",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Maryland MCHP - Priority Partners",
          "slug": "priority-md-chip",
          "id": "MD-CHIP-PRIORITY",
          "lob": "CHIP",
          "lobCode": "CHIP",
          "parent": "Johns Hopkins",
          "pbm": "PP PBM",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Maryland MCHP - Amerigroup",
          "slug": "amerigroup-md-chip",
          "id": "MD-CHIP-AMERIGROUP",
          "lob": "CHIP",
          "lobCode": "CHIP",
          "parent": "Elevance Health",
          "pbm": "Elevance PBM",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Novitas Solutions (MD)",
          "slug": "NOVITAS",
          "id": "MD-MAC-NOVITAS",
          "lob": "Medicare MAC",
          "lobCode": "MAC",
          "parent": "Novitas",
          "pbm": "N/A - Medical Benefit",
          "url": "https://www.novitas-solutions.com/",
          "turnaround": "N/A - Post-service",
          "expedited": "N/A - Post-service",
          "goldCard": "N/A - Federal Medicare",
          "channel": "Claims-based / LCD compliance"
        },
        {
          "name": "Maryland Physicians Care",
          "slug": "MPC",
          "id": "MD-MCD-MPC",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "MPC",
          "pbm": "State SPBM",
          "url": "https://www.marylandphysicianscare.com/",
          "turnaround": "7 days",
          "expedited": "72 hours",
          "goldCard": "N/A - Medicaid",
          "channel": "State Medicaid Portal"
        }
      ],
      "MA": [
        {
          "name": "Aetna",
          "slug": "AETNA",
          "id": "MA-COM-AETNA",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "CVS Health",
          "pbm": "CVS Caremark",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Blue Cross Blue Shield of Massachusetts",
          "slug": "MASSBCBS",
          "id": "MA-COM-MASSBCBS",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "BCBSMA",
          "pbm": "Prime Therapeutics",
          "url": "https://www.bluecrossma.org/providers/",
          "turnaround": "7 calendar days",
          "expedited": "72 hours",
          "goldCard": "NO - H.4616 pending",
          "channel": "BCBSMA Provider Portal"
        },
        {
          "name": "Fallon Health",
          "slug": "FALLON",
          "id": "MA-COM-FALLON",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "Fallon Community Health Plan",
          "pbm": "Express Scripts",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Harvard Pilgrim Health Care",
          "slug": "HARVARD",
          "id": "MA-COM-HARVARD",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "Point32Health",
          "pbm": "Express Scripts",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Tufts Health Plan",
          "slug": "TUFTS",
          "id": "MA-COM-TUFTS",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "Point32Health",
          "pbm": "Express Scripts",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "UnitedHealthcare",
          "slug": "UHC",
          "id": "MA-COM-UHC",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "UnitedHealth Group",
          "pbm": "OptumRx",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "BMC HealthNet Plan",
          "slug": "BMCHEALTH",
          "id": "MA-MCD-BMCHEALTH",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "Boston Medical Center",
          "pbm": "Express Scripts",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Fallon Health",
          "slug": "FALLON",
          "id": "MA-MCD-FALLON",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "Fallon Health",
          "pbm": "Express Scripts",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Health New England",
          "slug": "HEALTHNEW",
          "id": "MA-MCD-HEALTHNEW",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "Baystate Health",
          "pbm": "Express Scripts",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Mass General Brigham Health Plan",
          "slug": "MASSBRIGHAM",
          "id": "MA-MCD-MASSBRIGHAM",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "Mass General Brigham",
          "pbm": "Express Scripts",
          "url": "https://www.massgeneralbrigham.org/healthplan/",
          "turnaround": "7 calendar days",
          "expedited": "72 hours",
          "goldCard": "N/A - Mixed",
          "channel": "MGB Provider Portal"
        },
        {
          "name": "Tufts Health Plan",
          "slug": "TUFTS",
          "id": "MA-MCD-TUFTS",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "Point32Health",
          "pbm": "Express Scripts",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "WellSense Health Plan",
          "slug": "WELLSENSE",
          "id": "MA-MCD-WELLSENSE",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "WellSense",
          "pbm": "Express Scripts",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Aetna Medicare",
          "slug": "AETNACARE",
          "id": "MA-MA-AETNACARE",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "CVS Health",
          "pbm": "CVS Caremark",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Blue Cross Blue Shield of MA",
          "slug": "MABCBS",
          "id": "MA-MA-MABCBS",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "Blue Cross Blue Shield of MA",
          "pbm": "Prime Therapeutics",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Harvard Pilgrim Health Care",
          "slug": "HARVARD",
          "id": "MA-MA-HARVARD",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "Point32Health",
          "pbm": "Express Scripts",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Humana",
          "slug": "HUMANA",
          "id": "MA-MA-HUMANA",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "Humana Inc.",
          "pbm": "Humana Pharmacy Solutions",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Tufts Health Plan",
          "slug": "TUFTS",
          "id": "MA-MA-TUFTS",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "Point32Health",
          "pbm": "Express Scripts",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "UnitedHealthcare",
          "slug": "UHC",
          "id": "MA-MA-UHC",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "UnitedHealth Group",
          "pbm": "OptumRx",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "MassHealth (Medicaid)",
          "slug": "masshealth",
          "id": "MA-MCD-MASSHEALTH",
          "lob": "Medicaid Unified",
          "lobCode": "MCD",
          "parent": "MA Executive Office of Health and Human Services",
          "pbm": "Conduent (FFS) / OptumRx-CVS for ACOs",
          "url": "https://www.mass.gov/masshealth-pharmacy/",
          "turnaround": "⚠️ 7 calendar days (CMS-0057-F)",
          "expedited": "72 hours",
          "goldCard": "NO - H.4616 in committee until March 2026",
          "channel": "GAMMIS / ACO Portals"
        },
        {
          "name": "Point32Health (Harvard Pilgrim/Tufts)",
          "slug": "point32health",
          "id": "MA-COM-POINT32",
          "lob": "Commercial",
          "lobCode": "COM",
          "parent": "Point32Health",
          "pbm": "Point32Health PBM",
          "url": "https://www.point32health.org/provider/",
          "turnaround": "7 calendar days",
          "expedited": "72 hours",
          "goldCard": "NO - H.4616 pending",
          "channel": "Point32Health Portal"
        },
        {
          "name": "National Government Services (NGS)",
          "slug": "ngs-jk-ma",
          "id": "MA-PARTB-NGS",
          "lob": "PARTB",
          "lobCode": "PARTB",
          "parent": "National Government Services",
          "pbm": "N/A - Medicare",
          "url": "https://www.ngsmedicare.com/",
          "turnaround": "N/A - Post-service review (FFS)",
          "expedited": null,
          "goldCard": "N/A - Federal Medicare",
          "channel": "NGS Portal / esMD"
        },
        {
          "name": "Massachusetts MassHealth - All plans",
          "slug": "masshealth-ma-chip",
          "id": "MA-CHIP-MASSHEALTH",
          "lob": "CHIP",
          "lobCode": "CHIP",
          "parent": "Commonwealth of Massachusetts",
          "pbm": "MassHealth PBM",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Massachusetts MassHealth - BMC HealthNet",
          "slug": "bmchealthnet-ma-chip",
          "id": "MA-CHIP-BMC",
          "lob": "CHIP",
          "lobCode": "CHIP",
          "parent": "Boston Medical Center",
          "pbm": "BMC PBM",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Massachusetts MassHealth - Tufts Health Plan",
          "slug": "tufts-ma-chip",
          "id": "MA-CHIP-TUFTS",
          "lob": "CHIP",
          "lobCode": "CHIP",
          "parent": "Point32Health",
          "pbm": "Tufts PBM",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "National Government Services (MA)",
          "slug": "NGS",
          "id": "MA-MAC-NGS",
          "lob": "Medicare MAC",
          "lobCode": "MAC",
          "parent": "NGS",
          "pbm": "N/A - Medical Benefit",
          "url": "https://www.ngsmedicare.com/",
          "turnaround": "N/A - Post-service",
          "expedited": "N/A - Post-service",
          "goldCard": "N/A - Federal Medicare",
          "channel": "Claims-based / LCD compliance"
        },
        {
          "name": "Blue Cross Blue Shield of Massachusetts (Cluster)",
          "slug": "bcbsma-cluster",
          "id": "MA-COM-BCBSMA-CLUSTER",
          "lob": "Commercial",
          "lobCode": "COM",
          "parent": "Blue Cross Blue Shield Association",
          "pbm": null,
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "MassHealth",
          "slug": "MASSHLTH",
          "id": "MA-MCD-MASSHLTH",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": null,
          "pbm": null,
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Health Safety Net (HSN)",
          "slug": "HSN",
          "id": "MA-MCD-HSN",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": null,
          "pbm": null,
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        }
      ],
      "MI": [
        {
          "name": "Aetna",
          "slug": "AETNA",
          "id": "MI-COM-AETNA",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "CVS Health",
          "pbm": "CVS Caremark",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Blue Cross Blue Shield of Michigan",
          "slug": "MICHBCBS",
          "id": "MI-COM-MICHBCBS",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "BCBSM",
          "pbm": "Prime Therapeutics",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "HAP (Health Alliance Plan)",
          "slug": "ALLIANCE",
          "id": "MI-COM-ALLIANCE",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "Henry Ford Health",
          "pbm": "Express Scripts",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Priority Health",
          "slug": "PRIORITY",
          "id": "MI-COM-PRIORITY",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "Spectrum Health",
          "pbm": "Express Scripts",
          "url": "https://www.priorityhealth.com/",
          "turnaround": "Standard",
          "expedited": "Expedited",
          "goldCard": "⚠️ MCL 500.2212e excludes self-funded/ASO",
          "channel": "Priority Health Portal"
        },
        {
          "name": "UnitedHealthcare",
          "slug": "UHC",
          "id": "MI-COM-UHC",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "UnitedHealth Group",
          "pbm": "OptumRx",
          "url": "https://www.uhcprovider.com/",
          "turnaround": "Standard",
          "expedited": "Expedited",
          "goldCard": "✓ National Gold Card (92%); excludes Part D",
          "channel": "Optum Pro Portal"
        },
        {
          "name": "Aetna Better Health of Michigan",
          "slug": "AETNABETTER",
          "id": "MI-MCD-AETNABETTER",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "CVS Health",
          "pbm": "CVS Caremark",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Blue Cross Complete of Michigan",
          "slug": "MIBCBS",
          "id": "MI-MCD-MIBCBS",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "Blue Cross Blue Shield of Michigan",
          "pbm": "Prime Therapeutics",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "HAP Midwest Health Plan",
          "slug": "HAPMIDWEST",
          "id": "MI-MCD-HAPMIDWEST",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "Henry Ford Health",
          "pbm": "Express Scripts",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "McLaren Health Plan",
          "slug": "MCLARENHEALTH",
          "id": "MI-MCD-MCLARENHEALTH",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "McLaren Health Care",
          "pbm": "Express Scripts",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Meridian Health Plan of Michigan",
          "slug": "MERIDIAN",
          "id": "MI-MCD-MERIDIAN",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "Centene",
          "pbm": "Envolve Pharmacy Solutions",
          "url": "https://www.mhplan.com/",
          "turnaround": "Standard",
          "expedited": "Expedited",
          "goldCard": "N/A - Medicaid",
          "channel": "Centene Portal"
        },
        {
          "name": "Molina Healthcare of Michigan",
          "slug": "MOLINA",
          "id": "MI-MCD-MOLINA",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "Molina Healthcare",
          "pbm": "CVS Caremark",
          "url": "https://www.molinahealthcare.com/",
          "turnaround": "Standard",
          "expedited": "Expedited",
          "goldCard": "N/A - Medicaid",
          "channel": "Molina Portal"
        },
        {
          "name": "Priority Health",
          "slug": "PRIORITYHEALTH",
          "id": "MI-MCD-PRIORITYHEALTH",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "Spectrum Health",
          "pbm": "Express Scripts",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "UnitedHealthcare Community Plan Michigan",
          "slug": "UHC",
          "id": "MI-MCD-UHC",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "UnitedHealth Group",
          "pbm": "OptumRx",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Aetna Medicare",
          "slug": "AETNACARE",
          "id": "MI-MA-AETNACARE",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "CVS Health",
          "pbm": "CVS Caremark",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Blue Cross Blue Shield of Michigan",
          "slug": "MIBCBS",
          "id": "MI-MA-MIBCBS",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "BCBSM",
          "pbm": "Prime Therapeutics",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Humana",
          "slug": "HUMANA",
          "id": "MI-MA-HUMANA",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "Humana Inc.",
          "pbm": "Humana Pharmacy Solutions",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Priority Health",
          "slug": "PRIORITYH",
          "id": "MI-MA-PRIORITYH",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "Spectrum Health",
          "pbm": "Express Scripts",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "UnitedHealthcare",
          "slug": "UHC",
          "id": "MI-MA-UHC",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "UnitedHealth Group",
          "pbm": "OptumRx",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Blue Cross Blue Shield Michigan",
          "slug": "bcbsm-mi",
          "id": "MI-COM-BCBSM",
          "lob": "Commercial",
          "lobCode": "COM",
          "parent": "BCBSM",
          "pbm": "BCBSM PBM",
          "url": "https://www.bcbsm.com/",
          "turnaround": "Standard",
          "expedited": "Expedited",
          "goldCard": "✓ MCL 500.2212e (90% / fully insured only)",
          "channel": "BCBSM Portal"
        },
        {
          "name": "Blue Cross Complete Michigan",
          "slug": "bcc-mi",
          "id": "MI-MCD-BCC",
          "lob": "Medicaid MCO",
          "lobCode": "MCD",
          "parent": "BCBSM",
          "pbm": "BCBSM PBM",
          "url": "https://www.mibluecrosscomplete.com/",
          "turnaround": "Standard",
          "expedited": "Expedited",
          "goldCard": "N/A - Medicaid",
          "channel": "BCBSM Portal"
        },
        {
          "name": "WPS GHA (MI)",
          "slug": "wps-j8-mi",
          "id": "MI-PARTB-WPS",
          "lob": "PARTB",
          "lobCode": "PARTB",
          "parent": "WPS Government Health Administrators",
          "pbm": null,
          "url": "https://www.wpsgha.com/",
          "turnaround": "LCD",
          "expedited": null,
          "goldCard": "N/A - Federal",
          "channel": "WPS Portal"
        },
        {
          "name": "Michigan MIChild - Molina",
          "slug": "molina-mi-chip",
          "id": "MI-CHIP-MOLINA",
          "lob": "CHIP",
          "lobCode": "CHIP",
          "parent": "Molina Healthcare",
          "pbm": "CVS Caremark",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Michigan MIChild - Blue Cross Complete",
          "slug": "bcbsmi-chip",
          "id": "MI-CHIP-BCBSM",
          "lob": "CHIP",
          "lobCode": "CHIP",
          "parent": "BCBSM",
          "pbm": "BCBSM PBM",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Michigan MIChild - Meridian",
          "slug": "meridian-mi-chip",
          "id": "MI-CHIP-MERIDIAN",
          "lob": "CHIP",
          "lobCode": "CHIP",
          "parent": "Centene",
          "pbm": "Centene PBM",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Michigan MIChild - UnitedHealthcare CP",
          "slug": "uhc-mi-chip",
          "id": "MI-CHIP-UHC",
          "lob": "CHIP",
          "lobCode": "CHIP",
          "parent": "UnitedHealth Group",
          "pbm": "OptumRx",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "WPS Government Health Administrators (MI)",
          "slug": "WPS",
          "id": "MI-MAC-WPS",
          "lob": "Medicare MAC",
          "lobCode": "MAC",
          "parent": "WPS",
          "pbm": "N/A - Medical Benefit",
          "url": "https://www.wpsgha.com/",
          "turnaround": "N/A - Post-service",
          "expedited": "N/A - Post-service",
          "goldCard": "N/A - Federal Medicare",
          "channel": "Claims-based / LCD compliance"
        },
        {
          "name": "BCBS MI",
          "slug": "BCBSMI",
          "id": "MI-COM-BCBSMI",
          "lob": "COM",
          "lobCode": "COM",
          "parent": null,
          "pbm": null,
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "HAP CareSource MI Coordinated Health",
          "slug": "HAPCARESOURCE",
          "id": "MI-MA-HAPCARESOURCE",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "HAP / CareSource",
          "pbm": null,
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Physician Health Plan (University of Michigan Health Plan)",
          "slug": "PHP",
          "id": "MI-COM-PHP",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "University of Michigan Health",
          "pbm": null,
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        }
      ],
      "MS": [
        {
          "name": "Aetna",
          "slug": "AETNA",
          "id": "MS-COM-AETNA",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "CVS Health",
          "pbm": "CVS Caremark",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Ambetter",
          "slug": "AMBET",
          "id": "MS-COM-AMBET",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "Centene",
          "pbm": "Express Scripts",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Blue Cross Blue Shield of Mississippi",
          "slug": "MISSBCBS",
          "id": "MS-COM-MISSBCBS",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "BCBSMS",
          "pbm": "Prime Therapeutics",
          "url": null,
          "turnaround": null,
          "expedited": null,
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          "channel": null
        },
        {
          "name": "Humana",
          "slug": "HUMANA",
          "id": "MS-COM-HUMANA",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "Humana Inc.",
          "pbm": "Humana Pharmacy Solutions",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "UnitedHealthcare",
          "slug": "UHC",
          "id": "MS-COM-UHC",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "UnitedHealth Group",
          "pbm": "OptumRx",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Magnolia Health",
          "slug": "MAGNOLIA",
          "id": "MS-MCD-MAGNOLIA",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "Centene",
          "pbm": "Envolve Pharmacy Solutions",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Molina Healthcare of Mississippi",
          "slug": "MOLINA",
          "id": "MS-MCD-MOLINA",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "Molina Healthcare",
          "pbm": "CVS Caremark",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "UnitedHealthcare Community Plan Mississippi",
          "slug": "UHC",
          "id": "MS-MCD-UHC",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "UnitedHealth Group",
          "pbm": "OptumRx",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Aetna Medicare",
          "slug": "AETNACARE",
          "id": "MS-MA-AETNACARE",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "CVS Health",
          "pbm": "CVS Caremark",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Blue Cross Blue Shield of Mississippi",
          "slug": "MIBCBS",
          "id": "MS-MA-MIBCBS",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "BCBSMS",
          "pbm": "Prime Therapeutics",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Humana",
          "slug": "HUMANA",
          "id": "MS-MA-HUMANA",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "Humana Inc.",
          "pbm": "Humana Pharmacy Solutions",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "UnitedHealthcare",
          "slug": "UHC",
          "id": "MS-MA-UHC",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "UnitedHealth Group",
          "pbm": "OptumRx",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Blue Cross Blue Shield Mississippi",
          "slug": "bcbsms-ms",
          "id": "MS-COM-BCBSMS",
          "lob": "Commercial",
          "lobCode": "COM",
          "parent": "BCBSMS",
          "pbm": "BCBSMS PBM",
          "url": "https://www.bcbsms.com/",
          "turnaround": "2 biz days pharma / 7 days medical (SB 2140)",
          "expedited": "24-48 hours",
          "goldCard": "⚠️ SB 2140 transparency (not performance Gold Card)",
          "channel": "BCBSMS Portal"
        },
        {
          "name": "TrueCare Mississippi (Mississippi True)",
          "slug": "truecare-ms",
          "id": "MS-MCD-TRUECARE",
          "lob": "Medicaid MCO",
          "lobCode": "MCD",
          "parent": "TrueCare",
          "pbm": "TrueCare PBM",
          "url": "https://www.truecarehealth.com/",
          "turnaround": "2 biz days",
          "expedited": "24 hours",
          "goldCard": "N/A - Medicaid",
          "channel": "TrueCare Portal"
        },
        {
          "name": "Novitas Solutions (MS)",
          "slug": "novitas-jh-ms",
          "id": "MS-PARTB-NOVITAS",
          "lob": "PARTB",
          "lobCode": "PARTB",
          "parent": "Novitas Solutions",
          "pbm": null,
          "url": "https://www.novitas-solutions.com/",
          "turnaround": "LCD",
          "expedited": null,
          "goldCard": "N/A - Federal",
          "channel": "Novitas Portal"
        },
        {
          "name": "Mississippi CHIP - Magnolia",
          "slug": "magnolia-ms-chip",
          "id": "MS-CHIP-MAGNOLIA",
          "lob": "CHIP",
          "lobCode": "CHIP",
          "parent": "Centene",
          "pbm": "Centene PBM",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Mississippi CHIP - Molina",
          "slug": "molina-ms-chip",
          "id": "MS-CHIP-MOLINA",
          "lob": "CHIP",
          "lobCode": "CHIP",
          "parent": "Molina Healthcare",
          "pbm": "CVS Caremark",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Mississippi CHIP - UnitedHealthcare CP",
          "slug": "uhc-ms-chip",
          "id": "MS-CHIP-UHC",
          "lob": "CHIP",
          "lobCode": "CHIP",
          "parent": "UnitedHealth Group",
          "pbm": "OptumRx",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Novitas Solutions (MS)",
          "slug": "NOVITAS",
          "id": "MS-MAC-NOVITAS",
          "lob": "Medicare MAC",
          "lobCode": "MAC",
          "parent": "Novitas",
          "pbm": "N/A - Medical Benefit",
          "url": "https://www.novitas-solutions.com/",
          "turnaround": "N/A - Post-service",
          "expedited": "N/A - Post-service",
          "goldCard": "N/A - Federal Medicare",
          "channel": "Claims-based / LCD compliance"
        },
        {
          "name": "Mississippi Medicaid FFS",
          "slug": "MSDOM",
          "id": "MS-MCD-MSDOM",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "MS DOM",
          "pbm": "State SPBM",
          "url": "https://medicaid.ms.gov/",
          "turnaround": "7 days",
          "expedited": "72 hours",
          "goldCard": "N/A - Medicaid",
          "channel": "State Medicaid Portal"
        },
        {
          "name": "Oscar Health",
          "slug": "OSCAR",
          "id": "MS-ACA-OSCAR",
          "lob": "ACA",
          "lobCode": "ACA",
          "parent": "Oscar Health",
          "pbm": null,
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Mississippi CHIP TrueCare",
          "slug": "TRUECARE",
          "id": "MS-CHIP-TRUECARE",
          "lob": "CHIP",
          "lobCode": "CHIP",
          "parent": null,
          "pbm": null,
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        }
      ],
      "MO": [
        {
          "name": "Aetna",
          "slug": "AETNA",
          "id": "MO-COM-AETNA",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "CVS Health",
          "pbm": "CVS Caremark",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Ambetter",
          "slug": "AMBET",
          "id": "MO-COM-AMBET",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "Centene",
          "pbm": "Express Scripts",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Cigna",
          "slug": "CIGNA",
          "id": "MO-COM-CIGNA",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "Cigna",
          "pbm": "Express Scripts",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Elevance Health (Anthem)",
          "slug": "ELEV",
          "id": "MO-COM-ELEV",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "Elevance Health",
          "pbm": "IngenioRx (Carelon)",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "UnitedHealthcare",
          "slug": "UHC",
          "id": "MO-COM-UHC",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "UnitedHealth Group",
          "pbm": "OptumRx",
          "url": "https://www.uhcprovider.com/",
          "turnaround": "Standard",
          "expedited": "Expedited",
          "goldCard": "✓ HB 618 Gold Card (90%) + National voluntary",
          "channel": "Optum Pro Portal"
        },
        {
          "name": "Healthy Blue",
          "slug": "HEALTHYBLUE",
          "id": "MO-MCD-HEALTHYBLUE",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "Elevance Health",
          "pbm": "IngenioRx (Carelon)",
          "url": "https://www.healthybluemo.com/",
          "turnaround": "Standard",
          "expedited": "Expedited",
          "goldCard": "N/A - Medicaid",
          "channel": "Elevance Portal"
        },
        {
          "name": "Home State Health",
          "slug": "HOMESTATE",
          "id": "MO-MCD-HOMESTATE",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "Centene",
          "pbm": "Envolve Pharmacy Solutions",
          "url": "https://www.homestatehealth.com/",
          "turnaround": "Standard",
          "expedited": "Expedited",
          "goldCard": "N/A - Medicaid",
          "channel": "Centene Portal"
        },
        {
          "name": "UnitedHealthcare Community Plan Missouri",
          "slug": "UHC",
          "id": "MO-MCD-UHC",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "UnitedHealth Group",
          "pbm": "OptumRx",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Aetna Medicare",
          "slug": "AETNACARE",
          "id": "MO-MA-AETNACARE",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "CVS Health",
          "pbm": "CVS Caremark",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Anthem (Elevance)",
          "slug": "ELEV",
          "id": "MO-MA-ELEV",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "Elevance Health",
          "pbm": "IngenioRx (Carelon)",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Cigna HealthSpring",
          "slug": "CIGNA",
          "id": "MO-MA-CIGNA",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "Cigna",
          "pbm": "Express Scripts",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Humana",
          "slug": "HUMANA",
          "id": "MO-MA-HUMANA",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "Humana Inc.",
          "pbm": "Humana Pharmacy Solutions",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "UnitedHealthcare",
          "slug": "UHC",
          "id": "MO-MA-UHC",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "UnitedHealth Group",
          "pbm": "OptumRx",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "MO HealthNet (Medicaid)",
          "slug": "mo-healthnet",
          "id": "MO-MCD-MHN",
          "lob": "Medicaid FFS",
          "lobCode": "MCD",
          "parent": "MO DSS",
          "pbm": "MO HealthNet PBM",
          "url": "https://dss.mo.gov/mhd/",
          "turnaround": "Standard",
          "expedited": "Expedited",
          "goldCard": "N/A - Medicaid",
          "channel": "MO HealthNet Portal"
        },
        {
          "name": "Anthem Missouri",
          "slug": "anthem-mo",
          "id": "MO-COM-ANTHEM",
          "lob": "Commercial",
          "lobCode": "COM",
          "parent": "Elevance Health",
          "pbm": "Elevance PBM",
          "url": "https://www.anthem.com/",
          "turnaround": "Standard",
          "expedited": "Expedited",
          "goldCard": "⚠️ HB 618 resistant - strict pharmacy exclusion interpretation",
          "channel": "Availity"
        },
        {
          "name": "Blue Cross Blue Shield Kansas City",
          "slug": "bluekc-mo",
          "id": "MO-COM-BLUEKC",
          "lob": "Commercial",
          "lobCode": "COM",
          "parent": "Blue KC",
          "pbm": "Blue KC PBM",
          "url": "https://www.bluekc.com/",
          "turnaround": "Standard",
          "expedited": "Expedited",
          "goldCard": "⚠️ HB 618 applies",
          "channel": "Blue KC Portal"
        },
        {
          "name": "WPS GHA (MO)",
          "slug": "wps-j5-mo",
          "id": "MO-PARTB-WPS",
          "lob": "PARTB",
          "lobCode": "PARTB",
          "parent": "WPS Government Health Administrators",
          "pbm": null,
          "url": "https://www.wpsgha.com/",
          "turnaround": "LCD",
          "expedited": null,
          "goldCard": "N/A - Federal",
          "channel": "WPS Portal"
        },
        {
          "name": "Missouri MO HealthNet for Kids - Home State Health",
          "slug": "homestate-mo-chip",
          "id": "MO-CHIP-HOMESTATE",
          "lob": "CHIP",
          "lobCode": "CHIP",
          "parent": "Centene",
          "pbm": "Centene PBM",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Missouri MO HealthNet for Kids - UnitedHealthcare CP",
          "slug": "uhc-mo-chip",
          "id": "MO-CHIP-UHC",
          "lob": "CHIP",
          "lobCode": "CHIP",
          "parent": "UnitedHealth Group",
          "pbm": "OptumRx",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Missouri MO HealthNet for Kids - Anthem",
          "slug": "anthem-mo-chip",
          "id": "MO-CHIP-ANTHEM",
          "lob": "CHIP",
          "lobCode": "CHIP",
          "parent": "Elevance Health",
          "pbm": "Elevance PBM",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "WPS Government Health Administrators (MO)",
          "slug": "WPS",
          "id": "MO-MAC-WPS",
          "lob": "Medicare MAC",
          "lobCode": "MAC",
          "parent": "WPS",
          "pbm": "N/A - Medical Benefit",
          "url": "https://www.wpsgha.com/",
          "turnaround": "N/A - Post-service",
          "expedited": "N/A - Post-service",
          "goldCard": "N/A - Federal Medicare",
          "channel": "Claims-based / LCD compliance"
        },
        {
          "name": "Medica Insurance Company",
          "slug": "MEDICA",
          "id": "MO-ACA-MEDICA",
          "lob": "ACA",
          "lobCode": "ACA",
          "parent": "Medica",
          "pbm": null,
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Oscar Insurance Company",
          "slug": "OSCAR",
          "id": "MO-ACA-OSCAR",
          "lob": "ACA",
          "lobCode": "ACA",
          "parent": "Oscar Health",
          "pbm": null,
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Cox Health Systems Insurance Company",
          "slug": "COX",
          "id": "MO-ACA-COX",
          "lob": "ACA",
          "lobCode": "ACA",
          "parent": "CoxHealth",
          "pbm": null,
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        }
      ],
      "NE": [
        {
          "name": "Aetna",
          "slug": "AETNA",
          "id": "NE-COM-AETNA",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "CVS Health",
          "pbm": "CVS Caremark",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Ambetter",
          "slug": "AMBET",
          "id": "NE-COM-AMBET",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "Centene",
          "pbm": "Express Scripts",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Blue Cross Blue Shield of Nebraska",
          "slug": "NEBBCBS",
          "id": "NE-COM-NEBBCBS",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "BCBSNE",
          "pbm": "Prime Therapeutics",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Medica",
          "slug": "MEDICA",
          "id": "NE-COM-MEDICA",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "Medica",
          "pbm": "Express Scripts",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "UnitedHealthcare",
          "slug": "UHC",
          "id": "NE-COM-UHC",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "UnitedHealth Group",
          "pbm": "OptumRx",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Healthy Blue Nebraska",
          "slug": "HEALTHYBLUE",
          "id": "NE-MCD-HEALTHYBLUE",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "Elevance Health",
          "pbm": "IngenioRx (Carelon)",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Molina Healthcare of Nebraska",
          "slug": "MOLINA",
          "id": "NE-MCD-MOLINA",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "Molina Healthcare",
          "pbm": "CVS Caremark",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "UnitedHealthcare Community Plan Nebraska",
          "slug": "UHC",
          "id": "NE-MCD-UHC",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "UnitedHealth Group",
          "pbm": "OptumRx",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Aetna Medicare",
          "slug": "AETNACARE",
          "id": "NE-MA-AETNACARE",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "CVS Health",
          "pbm": "CVS Caremark",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Blue Cross Blue Shield of Nebraska",
          "slug": "NEBCBS",
          "id": "NE-MA-NEBCBS",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "BCBSNE",
          "pbm": "Prime Therapeutics",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Humana",
          "slug": "HUMANA",
          "id": "NE-MA-HUMANA",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "Humana Inc.",
          "pbm": "Humana Pharmacy Solutions",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "UnitedHealthcare",
          "slug": "UHC",
          "id": "NE-MA-UHC",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "UnitedHealth Group",
          "pbm": "OptumRx",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Blue Cross Blue Shield Nebraska",
          "slug": "bcbsne-ne",
          "id": "NE-COM-BCBSNE",
          "lob": "Commercial",
          "lobCode": "COM",
          "parent": "BCBSNE",
          "pbm": "Prime Therapeutics",
          "url": "https://www.nebraskablue.com/",
          "turnaround": "72 hours (LB 77)",
          "expedited": "24 hours",
          "goldCard": "⚠️ No statutory Gold Card",
          "channel": "BCBSNE Portal"
        },
        {
          "name": "Nebraska Medicaid (Heritage Health)",
          "slug": "ne-medicaid",
          "id": "NE-MCD-HERITAGE",
          "lob": "Medicaid FFS/MCO",
          "lobCode": "MCD",
          "parent": "NE DHHS",
          "pbm": "NE Medicaid PBM",
          "url": "https://dhhs.ne.gov/",
          "turnaround": "72 hours (LB 77)",
          "expedited": "24 hours",
          "goldCard": "N/A - Medicaid",
          "channel": "NE Medicaid Portal"
        },
        {
          "name": "WPS GHA (NE)",
          "slug": "wps-j5-ne",
          "id": "NE-PARTB-WPS",
          "lob": "PARTB",
          "lobCode": "PARTB",
          "parent": "WPS Government Health Administrators",
          "pbm": null,
          "url": "https://www.wpsgha.com/",
          "turnaround": "LCD",
          "expedited": null,
          "goldCard": "N/A - Federal",
          "channel": "WPS Portal"
        },
        {
          "name": "Nebraska CHIP - All plans",
          "slug": "ne-chip",
          "id": "NE-CHIP-NE",
          "lob": "CHIP",
          "lobCode": "CHIP",
          "parent": "State of Nebraska",
          "pbm": "NE DHHS",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "WPS Government Health Administrators (NE)",
          "slug": "WPS",
          "id": "NE-MAC-WPS",
          "lob": "Medicare MAC",
          "lobCode": "MAC",
          "parent": "WPS",
          "pbm": "N/A - Medical Benefit",
          "url": "https://www.wpsgha.com/",
          "turnaround": "N/A - Post-service",
          "expedited": "N/A - Post-service",
          "goldCard": "N/A - Federal Medicare",
          "channel": "Claims-based / LCD compliance"
        },
        {
          "name": "Nebraska Total Care",
          "slug": "NETOTALCARE",
          "id": "NE-MCD-NETOTALCARE",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "Centene",
          "pbm": null,
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Medica Advantage PPO",
          "slug": "MEDICA",
          "id": "NE-MA-MEDICA",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "Medica",
          "pbm": null,
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        }
      ],
      "NV": [
        {
          "name": "Aetna",
          "slug": "AETNA",
          "id": "NV-COM-AETNA",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "CVS Health",
          "pbm": "CVS Caremark",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Anthem (Elevance)",
          "slug": "ELEV",
          "id": "NV-COM-ELEV",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "Elevance Health",
          "pbm": "IngenioRx (Carelon)",
          "url": "https://www.anthem.com/",
          "turnaround": "2 business days",
          "expedited": "24 hours",
          "goldCard": null,
          "channel": "Availity/Anthem"
        },
        {
          "name": "Health Plan of Nevada",
          "slug": "HEALTHNEV",
          "id": "NV-COM-HEALTHNEV",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "UnitedHealth Group",
          "pbm": "OptumRx",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Prominence Health Plan",
          "slug": "PROMPLAN",
          "id": "NV-COM-PROMPLAN",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "Universal Health Services",
          "pbm": "Express Scripts",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "UnitedHealthcare",
          "slug": "UHC",
          "id": "NV-COM-UHC",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "UnitedHealth Group",
          "pbm": "OptumRx",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Anthem Blue Cross Blue Shield (Nevada)",
          "slug": "ANTHEM",
          "id": "NV-MCD-ANTHEM",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "Elevance Health",
          "pbm": "IngenioRx (Carelon)",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Health Plan of Nevada",
          "slug": "HEALTHNEVADA",
          "id": "NV-MCD-HEALTHNEVADA",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "UnitedHealth Group",
          "pbm": "OptumRx",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Molina Healthcare of Nevada",
          "slug": "MOLINA",
          "id": "NV-MCD-MOLINA",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "Molina Healthcare",
          "pbm": "CVS Caremark",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "SilverSummit Healthplan",
          "slug": "SLIVERSUMMIT",
          "id": "NV-MCD-SLIVERSUMMIT",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "Centene",
          "pbm": "Envolve Pharmacy Solutions",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Aetna Medicare",
          "slug": "AETNACARE",
          "id": "NV-MA-AETNACARE",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "CVS Health",
          "pbm": "CVS Caremark",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Anthem (Elevance)",
          "slug": "ELEV",
          "id": "NV-MA-ELEV",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "Elevance Health",
          "pbm": "IngenioRx (Carelon)",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Health Plan of Nevada",
          "slug": "NEVHEALTH",
          "id": "NV-MA-NEVHEALTH",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "UnitedHealth Group",
          "pbm": "OptumRx",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Humana",
          "slug": "HUMANA",
          "id": "NV-MA-HUMANA",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "Humana Inc.",
          "pbm": "Humana Pharmacy Solutions",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "UnitedHealthcare",
          "slug": "UHC",
          "id": "NV-MA-UHC",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "UnitedHealth Group",
          "pbm": "OptumRx",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Nevada Medicaid (sPDL)",
          "slug": "nevada-medicaid-spdl",
          "id": "NV-MCD-SPDL",
          "lob": "Medicaid Unified",
          "lobCode": "MCD",
          "parent": "NV DHHS/DHCFP",
          "pbm": "OptumRx/CVS",
          "url": "https://dhcfp.nv.gov/",
          "turnaround": "⚠️ 2 business days (AB 463)",
          "expedited": "24 hours urgent",
          "goldCard": "N/A - No Gold Card passed",
          "channel": "DHCFP Portal"
        },
        {
          "name": "Health Plan of Nevada (UHC)",
          "slug": "hpn-uhc-nv",
          "id": "NV-COM-HPN",
          "lob": "Commercial/Medicaid MCO",
          "lobCode": "COM",
          "parent": "UnitedHealth Group",
          "pbm": "OptumRx",
          "url": "https://www.uhcprovider.com/",
          "turnaround": "2 business days",
          "expedited": "24 hours",
          "goldCard": null,
          "channel": "UHC Provider Portal"
        },
        {
          "name": "SilverSummit/Ambetter Nevada",
          "slug": "silversummit-nv",
          "id": "NV-COM-AMBETTER",
          "lob": "Exchange/Medicaid",
          "lobCode": "COM",
          "parent": "Centene",
          "pbm": "CVS Caremark",
          "url": "https://www.silversummithealthplan.com/",
          "turnaround": "2 business days",
          "expedited": "24 hours",
          "goldCard": null,
          "channel": "Centene Portal"
        },
        {
          "name": "Noridian Healthcare Solutions (NV)",
          "slug": "noridian-je-nv",
          "id": "NV-PARTB-NORIDIAN",
          "lob": "PARTB",
          "lobCode": "PARTB",
          "parent": "Noridian Healthcare Solutions",
          "pbm": null,
          "url": "https://med.noridianmedicare.com/",
          "turnaround": "LCD",
          "expedited": null,
          "goldCard": "N/A - Federal",
          "channel": "Noridian Portal"
        },
        {
          "name": "Nevada Check Up - Anthem",
          "slug": "anthem-nv-chip",
          "id": "NV-CHIP-ANTHEM",
          "lob": "CHIP",
          "lobCode": "CHIP",
          "parent": "Elevance Health",
          "pbm": "Elevance PBM",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Nevada Check Up - Molina",
          "slug": "molina-nv-chip",
          "id": "NV-CHIP-MOLINA",
          "lob": "CHIP",
          "lobCode": "CHIP",
          "parent": "Molina Healthcare",
          "pbm": "CVS Caremark",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Nevada Check Up - Health Plan of Nevada",
          "slug": "hpn-nv-chip",
          "id": "NV-CHIP-HPN",
          "lob": "CHIP",
          "lobCode": "CHIP",
          "parent": "UnitedHealth Group",
          "pbm": "OptumRx",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Noridian Healthcare Solutions (NV)",
          "slug": "NORIDIAN",
          "id": "NV-MAC-NORIDIAN",
          "lob": "Medicare MAC",
          "lobCode": "MAC",
          "parent": "Noridian",
          "pbm": "N/A - Medical Benefit",
          "url": "https://med.noridianmedicare.com/",
          "turnaround": "N/A - Post-service",
          "expedited": "N/A - Post-service",
          "goldCard": "N/A - Federal Medicare",
          "channel": "Claims-based / LCD compliance"
        },
        {
          "name": "Nevada Medicaid FFS",
          "slug": "NVMEDICAID",
          "id": "NV-MCD-NVMEDICAID",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "NV DHCFP",
          "pbm": "State SPBM",
          "url": "https://dhcfp.nv.gov/",
          "turnaround": "7 days",
          "expedited": "72 hours",
          "goldCard": "N/A - Medicaid",
          "channel": "State Medicaid Portal"
        },
        {
          "name": "Multiple",
          "slug": "VARIOUS",
          "id": "NV-COM-VARIOUS",
          "lob": "COM",
          "lobCode": "COM",
          "parent": null,
          "pbm": null,
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Nevada Medicaid (DHCFP)",
          "slug": "NVMEDICAID-CLUSTER",
          "id": "NV-MCD-NVMEDICAID-CLUSTER",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": null,
          "pbm": null,
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "CareSource Nevada",
          "slug": "CARESOURCE",
          "id": "NV-ACA-CARESOURCE",
          "lob": "ACA",
          "lobCode": "ACA",
          "parent": "CareSource",
          "pbm": null,
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Champion Health Plan",
          "slug": "CHAMPION",
          "id": "NV-MA-CHAMPION",
          "lob": "MA",
          "lobCode": "MA",
          "parent": null,
          "pbm": null,
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        }
      ],
      "NH": [
        {
          "name": "Aetna",
          "slug": "AETNA",
          "id": "NH-COM-AETNA",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "CVS Health",
          "pbm": "CVS Caremark",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Ambetter",
          "slug": "AMBET",
          "id": "NH-COM-AMBET",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "Centene",
          "pbm": "Express Scripts",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Cigna",
          "slug": "CIGNA",
          "id": "NH-COM-CIGNA",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "Cigna",
          "pbm": "Express Scripts",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Elevance Health (Anthem)",
          "slug": "ELEV",
          "id": "NH-COM-ELEV",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "Elevance Health",
          "pbm": "IngenioRx (Carelon)",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Harvard Pilgrim",
          "slug": "HARVARD",
          "id": "NH-COM-HARVARD",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "Point32Health",
          "pbm": "Express Scripts",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "AmeriHealth Caritas New Hampshire",
          "slug": "AMERIHEALTH",
          "id": "NH-MCD-AMERIHEALTH",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "AmeriHealth Caritas",
          "pbm": "CVS Caremark",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Granite State Health Plan",
          "slug": "GRANITE",
          "id": "NH-MCD-GRANITE",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "Centene",
          "pbm": "Envolve Pharmacy Solutions",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Well Sense Health Plan NH",
          "slug": "WELLSENSE",
          "id": "NH-MCD-WELLSENSE",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "Boston Medical Center/WellSense",
          "pbm": "Express Scripts",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Aetna Medicare",
          "slug": "AETNACARE",
          "id": "NH-MA-AETNACARE",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "CVS Health",
          "pbm": "CVS Caremark",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Anthem (Elevance)",
          "slug": "ELEV",
          "id": "NH-MA-ELEV",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "Elevance Health",
          "pbm": "IngenioRx (Carelon)",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Humana",
          "slug": "HUMANA",
          "id": "NH-MA-HUMANA",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "Humana Inc.",
          "pbm": "Humana Pharmacy Solutions",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "UnitedHealthcare",
          "slug": "UHC",
          "id": "NH-MA-UHC",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "UnitedHealth Group",
          "pbm": "OptumRx",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Anthem BCBS New Hampshire",
          "slug": "anthem-nh",
          "id": "NH-COM-ANTHEM",
          "lob": "Commercial",
          "lobCode": "COM",
          "parent": "Elevance Health",
          "pbm": "CarelonRx",
          "url": "https://www.anthem.com/",
          "turnaround": "2 biz days (SB 561)",
          "expedited": "Expedited",
          "goldCard": "⚠️ SB 561 'Deemed Approved' if no response",
          "channel": "Anthem Portal"
        },
        {
          "name": "Harvard Pilgrim NH",
          "slug": "harvardpilgrim-nh",
          "id": "NH-COM-HARVARDPILGRIM",
          "lob": "Commercial",
          "lobCode": "COM",
          "parent": "Point32Health",
          "pbm": "OptumRx",
          "url": "https://www.harvardpilgrim.org/",
          "turnaround": "2 biz days (SB 561)",
          "expedited": "Expedited",
          "goldCard": "⚠️ SB 561 applies",
          "channel": "HPHC Portal"
        },
        {
          "name": "NH Healthy Families",
          "slug": "nhhealthyfamilies-nh",
          "id": "NH-MCD-HEALTHYFAMILIES",
          "lob": "Medicaid MCO",
          "lobCode": "MCD",
          "parent": "Centene",
          "pbm": "Envolve",
          "url": "https://www.nhhealthyfamilies.com/",
          "turnaround": "2 biz days",
          "expedited": "Expedited",
          "goldCard": "N/A - Medicaid",
          "channel": "Centene Portal"
        },
        {
          "name": "Ambetter New Hampshire",
          "slug": "ambetter-nh",
          "id": "NH-COM-AMBETTER",
          "lob": "Commercial",
          "lobCode": "COM",
          "parent": "Centene",
          "pbm": "Centene PBM",
          "url": "https://www.ambetterhealth.com/",
          "turnaround": "2 biz days (SB 561)",
          "expedited": "Expedited",
          "goldCard": "⚠️ SB 561 applies",
          "channel": "Ambetter Portal"
        },
        {
          "name": "NGS (New Hampshire)",
          "slug": "ngs-jk-nh",
          "id": "NH-PARTB-NGS",
          "lob": "PARTB",
          "lobCode": "PARTB",
          "parent": "National Government Services",
          "pbm": null,
          "url": "https://www.ngsmedicare.com/",
          "turnaround": "LCD",
          "expedited": null,
          "goldCard": "N/A - Federal",
          "channel": "NGS Portal"
        },
        {
          "name": "New Hampshire Healthy Kids - NH Healthy Families",
          "slug": "nhhf-nh-chip",
          "id": "NH-CHIP-NHHF",
          "lob": "CHIP",
          "lobCode": "CHIP",
          "parent": "Centene",
          "pbm": "Envolve",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "National Government Services (NH)",
          "slug": "NGS",
          "id": "NH-MAC-NGS",
          "lob": "Medicare MAC",
          "lobCode": "MAC",
          "parent": "NGS",
          "pbm": "N/A - Medical Benefit",
          "url": "https://www.ngsmedicare.com/",
          "turnaround": "N/A - Post-service",
          "expedited": "N/A - Post-service",
          "goldCard": "N/A - Federal Medicare",
          "channel": "Claims-based / LCD compliance"
        },
        {
          "name": "Martin's Point Health Care",
          "slug": "MARTINSPOINT",
          "id": "NH-MA-MARTINSPOINT",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "Martin's Point Health Care",
          "pbm": null,
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        }
      ],
      "NJ": [
        {
          "name": "Aetna",
          "slug": "AETNA",
          "id": "NJ-COM-AETNA",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "CVS Health",
          "pbm": "CVS Caremark",
          "url": "https://www.aetna.com/providers/",
          "turnaround": "72 hours (A1825)",
          "expedited": "24 hours (urgent)",
          "goldCard": "A1825 Step Therapy Override applies",
          "channel": "Aetna Provider Portal / CVS Caremark"
        },
        {
          "name": "AmeriHealth",
          "slug": "AMERI",
          "id": "NJ-COM-AMERI",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "Independence Health Group",
          "pbm": "Express Scripts",
          "url": "https://www.amerihealth.com/providers/",
          "turnaround": "72 hours (A1825)",
          "expedited": "24 hours (urgent)",
          "goldCard": "A1825 Step Therapy Override applies",
          "channel": "AmeriHealth Provider Portal"
        },
        {
          "name": "Cigna",
          "slug": "CIGNA",
          "id": "NJ-COM-CIGNA",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "Cigna",
          "pbm": "Express Scripts",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Horizon Blue Cross Blue Shield",
          "slug": "HORBCBS",
          "id": "NJ-COM-HORBCBS",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "Horizon BCBSNJ",
          "pbm": "Prime Therapeutics",
          "url": "https://www.horizonblue.com/providers/",
          "turnaround": "72 hours (A1825)",
          "expedited": "24 hours (urgent)",
          "goldCard": "A1825 Step Therapy Override applies; 72h response or deemed approved",
          "channel": "Horizon Provider Portal / CoverMyMeds"
        },
        {
          "name": "UnitedHealthcare",
          "slug": "UHC",
          "id": "NJ-COM-UHC",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "UnitedHealth Group",
          "pbm": "OptumRx",
          "url": "https://www.uhcprovider.com/",
          "turnaround": "72 hours (A1825)",
          "expedited": "24 hours (urgent)",
          "goldCard": "UHC Gold Card ACTIVE + A1825 applies",
          "channel": "UHC Provider Portal / OptumRx"
        },
        {
          "name": "Aetna Better Health of New Jersey",
          "slug": "AETNABETTER",
          "id": "NJ-MCD-AETNABETTER",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "CVS Health",
          "pbm": "CVS Caremark",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Amerigroup New Jersey",
          "slug": "AMERIGROUP",
          "id": "NJ-MCD-AMERIGROUP",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "Elevance Health",
          "pbm": "IngenioRx (Carelon)",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Horizon NJ Health",
          "slug": "HORIZON",
          "id": "NJ-MCD-HORIZON",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "Horizon Blue Cross Blue Shield",
          "pbm": "Prime Therapeutics",
          "url": "https://www.horizonnjhealth.com/providers/",
          "turnaround": "7 calendar days",
          "expedited": "72 hours",
          "goldCard": "A1825 applies",
          "channel": "Horizon NJ Health Portal / State Fax"
        },
        {
          "name": "Molina Healthcare of New Jersey",
          "slug": "MOLINA",
          "id": "NJ-MCD-MOLINA",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "Molina Healthcare",
          "pbm": "CVS Caremark",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "UnitedHealthcare Community Plan NJ",
          "slug": "UHC",
          "id": "NJ-MCD-UHC",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "UnitedHealth Group",
          "pbm": "OptumRx",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "WellCare of New Jersey",
          "slug": "WELLCARE",
          "id": "NJ-MCD-WELLCARE",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "Centene",
          "pbm": "Envolve Pharmacy Solutions",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Aetna Medicare",
          "slug": "AETNACARE",
          "id": "NJ-MA-AETNACARE",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "CVS Health",
          "pbm": "CVS Caremark",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Cigna HealthSpring",
          "slug": "CIGNA",
          "id": "NJ-MA-CIGNA",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "Cigna",
          "pbm": "Express Scripts",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Horizon Blue Cross Blue Shield NJ",
          "slug": "HORBCBS",
          "id": "NJ-MA-HORBCBS",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "Horizon BCBSNJ",
          "pbm": "Prime Therapeutics",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Humana",
          "slug": "HUMANA",
          "id": "NJ-MA-HUMANA",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "Humana Inc.",
          "pbm": "Humana Pharmacy Solutions",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "UnitedHealthcare",
          "slug": "UHC",
          "id": "NJ-MA-UHC",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "UnitedHealth Group",
          "pbm": "OptumRx",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Oscar Health NJ",
          "slug": "oscar-health-nj",
          "id": "NJ-COM-OSCAR",
          "lob": "Commercial",
          "lobCode": "COM",
          "parent": "Oscar Health",
          "pbm": "Oscar PBM",
          "url": "https://www.hioscar.com/providers/",
          "turnaround": "72 hours (A1825)",
          "expedited": "24 hours (urgent)",
          "goldCard": "A1825 Step Therapy Override applies",
          "channel": "Oscar Health Portal"
        },
        {
          "name": "NJ FamilyCare (Medicaid)",
          "slug": "nj-familycare",
          "id": "NJ-MCD-NJFC",
          "lob": "Medicaid Unified",
          "lobCode": "MCD",
          "parent": "NJ Dept of Human Services",
          "pbm": "State-managed",
          "url": "https://www.state.nj.us/humanservices/dmahs/",
          "turnaround": "7 calendar days",
          "expedited": "72 hours",
          "goldCard": "A1825 applies to NJ FamilyCare",
          "channel": "GAMMIS / State Fax Forms"
        },
        {
          "name": "Novitas Solutions",
          "slug": "novitas-solutions-jl",
          "id": "NJ-PARTB-NOVITAS",
          "lob": "PARTB",
          "lobCode": "PARTB",
          "parent": "Novitas Solutions",
          "pbm": "N/A - Medicare",
          "url": "https://www.novitas-solutions.com/",
          "turnaround": "WISeR Pre-Service Required",
          "expedited": null,
          "goldCard": "WISeR Gold Card - earn exemption through compliance",
          "channel": "Novitas Portal / esMD"
        },
        {
          "name": "New Jersey NJ FamilyCare - Horizon",
          "slug": "horizon-nj-chip",
          "id": "NJ-CHIP-HORIZON",
          "lob": "CHIP",
          "lobCode": "CHIP",
          "parent": "Horizon BCBSNJ",
          "pbm": "Horizon PBM",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "New Jersey NJ FamilyCare - Amerigroup",
          "slug": "amerigroup-nj-chip",
          "id": "NJ-CHIP-AMERIGROUP",
          "lob": "CHIP",
          "lobCode": "CHIP",
          "parent": "Elevance Health",
          "pbm": "Elevance PBM",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "New Jersey NJ FamilyCare - Aetna Better Health",
          "slug": "aetna-nj-chip",
          "id": "NJ-CHIP-AETNA",
          "lob": "CHIP",
          "lobCode": "CHIP",
          "parent": "CVS Health",
          "pbm": "CVS Caremark",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "New Jersey NJ FamilyCare - UnitedHealthcare CP",
          "slug": "uhc-nj-chip",
          "id": "NJ-CHIP-UHC",
          "lob": "CHIP",
          "lobCode": "CHIP",
          "parent": "UnitedHealth Group",
          "pbm": "OptumRx",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Novitas Solutions (NJ)",
          "slug": "NOVITAS",
          "id": "NJ-MAC-NOVITAS",
          "lob": "Medicare MAC",
          "lobCode": "MAC",
          "parent": "Novitas",
          "pbm": "N/A - Medical Benefit",
          "url": "https://www.novitas-solutions.com/",
          "turnaround": "N/A - Post-service",
          "expedited": "N/A - Post-service",
          "goldCard": "N/A - Federal Medicare",
          "channel": "Claims-based / LCD compliance"
        },
        {
          "name": "Aetna (Cluster Headache - NJ)",
          "slug": "aetna-cluster",
          "id": "NJ-COM-AETNA-CLUSTER",
          "lob": "Commercial",
          "lobCode": "COM",
          "parent": "CVS Health",
          "pbm": null,
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        }
      ],
      "NY": [
        {
          "name": "Aetna",
          "slug": "AETNA",
          "id": "NY-COM-AETNA",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "CVS Health",
          "pbm": "CVS Caremark",
          "url": "https://www.aetna.com/health-care-professionals.html",
          "turnaround": "7 calendar days",
          "expedited": "72 hours",
          "goldCard": "Pending (S7470 not codified)",
          "channel": "Availity / Aetna Provider Portal"
        },
        {
          "name": "Cigna",
          "slug": "CIGNA",
          "id": "NY-COM-CIGNA",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "Cigna",
          "pbm": "Express Scripts",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "EmblemHealth",
          "slug": "EMBLEM",
          "id": "NY-COM-EMBLEM",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "EmblemHealth",
          "pbm": "Express Scripts",
          "url": "https://www.emblemhealth.com/providers/",
          "turnaround": "7 calendar days",
          "expedited": "72 hours",
          "goldCard": "Pending (S7470 not codified)",
          "channel": "EmblemHealth Provider Portal"
        },
        {
          "name": "Empire BlueCross BlueShield",
          "slug": "EMPIREBCBS",
          "id": "NY-COM-EMPIREBCBS",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "Elevance Health",
          "pbm": "IngenioRx (Carelon)",
          "url": "https://www.empireblue.com/provider/",
          "turnaround": "7 calendar days",
          "expedited": "72 hours",
          "goldCard": "Pending (S7470 not codified)",
          "channel": "Availity / Carelon Portal"
        },
        {
          "name": "Excellus BlueCross BlueShield",
          "slug": "ECELBCBS",
          "id": "NY-COM-ECELBCBS",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "Excellus Health Plan",
          "pbm": "Prime Therapeutics",
          "url": "https://www.excellusbcbs.com/providers",
          "turnaround": "7 calendar days",
          "expedited": "72 hours",
          "goldCard": "Pending (S7470 not codified)",
          "channel": "Excellus Provider Portal"
        },
        {
          "name": "Oscar Health",
          "slug": "OSCAR",
          "id": "NY-COM-OSCAR",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "Oscar Health",
          "pbm": "Express Scripts",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "UnitedHealthcare",
          "slug": "UHC",
          "id": "NY-COM-UHC",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "UnitedHealth Group",
          "pbm": "OptumRx",
          "url": "https://www.uhcprovider.com/",
          "turnaround": "7 calendar days",
          "expedited": "72 hours",
          "goldCard": "Yes (Voluntary) - 92% threshold on specific codes; check portal for eligibility",
          "channel": "UHC Provider Portal / Link"
        },
        {
          "name": "Affinity Health Plan",
          "slug": "AFFINITY",
          "id": "NY-MCD-AFFINITY",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "Molina Healthcare",
          "pbm": "CVS Caremark",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Empire BlueCross BlueShield HealthPlus",
          "slug": "EMPIREBCBS",
          "id": "NY-MCD-EMPIREBCBS",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "Elevance Health",
          "pbm": "IngenioRx (Carelon)",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Fidelis Care",
          "slug": "FIDELIS",
          "id": "NY-MCD-FIDELIS",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "Centene",
          "pbm": "Envolve Pharmacy Solutions",
          "url": "https://www.fideliscare.org/Providers",
          "turnaround": "7 calendar days",
          "expedited": "72 hours",
          "goldCard": "N/A - Medicaid MCO",
          "channel": "Fidelis Provider Portal"
        },
        {
          "name": "Healthfirst",
          "slug": "HEALTHFIRST",
          "id": "NY-MCD-HEALTHFIRST",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "Healthfirst",
          "pbm": "CVS Caremark",
          "url": "https://healthfirst.org/providers/",
          "turnaround": "7 calendar days",
          "expedited": "72 hours",
          "goldCard": "N/A - Medicaid MCO",
          "channel": "Healthfirst Provider Portal"
        },
        {
          "name": "MetroPlus Health Plan",
          "slug": "METROPLUS",
          "id": "NY-MCD-METROPLUS",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "NYC Health + Hospitals",
          "pbm": "CVS Caremark",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Molina Healthcare of New York",
          "slug": "MOLINA",
          "id": "NY-MCD-MOLINA",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "Molina Healthcare",
          "pbm": "CVS Caremark",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "MVP Health Care",
          "slug": "MVPHEALTH",
          "id": "NY-MCD-MVPHEALTH",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "MVP Health Care",
          "pbm": "Express Scripts",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "UnitedHealthcare Community Plan NY",
          "slug": "UHC",
          "id": "NY-MCD-UHC",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "UnitedHealth Group",
          "pbm": "OptumRx",
          "url": "https://www.uhccommunityplan.com/ny",
          "turnaround": "7 calendar days",
          "expedited": "72 hours",
          "goldCard": "N/A - Medicaid MCO",
          "channel": "UHC Community Plan Portal"
        },
        {
          "name": "WellCare of New York",
          "slug": "WELLCARE",
          "id": "NY-MCD-WELLCARE",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "Centene",
          "pbm": "Envolve Pharmacy Solutions",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Aetna Medicare",
          "slug": "AETNACARE",
          "id": "NY-MA-AETNACARE",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "CVS Health",
          "pbm": "CVS Caremark",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "EmblemHealth",
          "slug": "EMBLEM",
          "id": "NY-MA-EMBLEM",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "EmblemHealth",
          "pbm": "Express Scripts",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Excellus BlueCross BlueShield",
          "slug": "ECELBCBS",
          "id": "NY-MA-ECELBCBS",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "Excellus Health Plan",
          "pbm": "Prime Therapeutics",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Fidelis Care",
          "slug": "FIDELIS",
          "id": "NY-MA-FIDELIS",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "Centene",
          "pbm": "Express Scripts",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Healthfirst",
          "slug": "HEALTHFIRST",
          "id": "NY-MA-HEALTHFIRST",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "Healthfirst",
          "pbm": "CVS Caremark",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Humana",
          "slug": "HUMANA",
          "id": "NY-MA-HUMANA",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "Humana Inc.",
          "pbm": "Humana Pharmacy Solutions",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "UnitedHealthcare",
          "slug": "UHC",
          "id": "NY-MA-UHC",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "UnitedHealth Group",
          "pbm": "OptumRx",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "NYRx (New York State Medicaid)",
          "slug": "nyrx-medicaid",
          "id": "NY-MCD-NYRX",
          "lob": "Medicaid FFS Pharmacy",
          "lobCode": "MCD",
          "parent": "New York State DHHS",
          "pbm": "Magellan Rx (State Contract)",
          "url": "https://www.health.ny.gov/health_care/medicaid/program/nyrx/",
          "turnaround": "7 calendar days",
          "expedited": "72 hours",
          "goldCard": "N/A - State Medicaid",
          "channel": "NYRx Portal / Magellan"
        },
        {
          "name": "National Government Services (NGS)",
          "slug": "ngs-mac-jk",
          "id": "NY-PARTB-NGS",
          "lob": "PARTB",
          "lobCode": "PARTB",
          "parent": "Anthem/Elevance",
          "pbm": "N/A - Medicare",
          "url": "https://www.ngsmedicare.com/",
          "turnaround": "N/A - LCD determines",
          "expedited": "N/A - LCD determines",
          "goldCard": "N/A - Federal Medicare",
          "channel": "NGS Medicare Portal"
        },
        {
          "name": "New York Child Health Plus - Fidelis Care",
          "slug": "fidelis-ny-chip",
          "id": "NY-CHIP-FIDELIS",
          "lob": "CHIP",
          "lobCode": "CHIP",
          "parent": "Centene",
          "pbm": "Centene PBM",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "New York Child Health Plus - Healthfirst",
          "slug": "healthfirst-ny-chip",
          "id": "NY-CHIP-HEALTHFIRST",
          "lob": "CHIP",
          "lobCode": "CHIP",
          "parent": "Healthfirst",
          "pbm": "Healthfirst PBM",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "New York Child Health Plus - EmblemHealth",
          "slug": "emblem-ny-chip",
          "id": "NY-CHIP-EMBLEM",
          "lob": "CHIP",
          "lobCode": "CHIP",
          "parent": "EmblemHealth",
          "pbm": "EmblemHealth PBM",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "New York Child Health Plus - MVP Health Care",
          "slug": "mvp-ny-chip",
          "id": "NY-CHIP-MVP",
          "lob": "CHIP",
          "lobCode": "CHIP",
          "parent": "MVP Health Care",
          "pbm": "MVP PBM",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "New York Child Health Plus - Molina",
          "slug": "molina-ny-chip",
          "id": "NY-CHIP-MOLINA",
          "lob": "CHIP",
          "lobCode": "CHIP",
          "parent": "Molina Healthcare",
          "pbm": "CVS Caremark",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "National Government Services (NY)",
          "slug": "NGS",
          "id": "NY-MAC-NGS",
          "lob": "Medicare MAC",
          "lobCode": "MAC",
          "parent": "NGS",
          "pbm": "N/A - Medical Benefit",
          "url": "https://www.ngsmedicare.com/",
          "turnaround": "N/A - Post-service",
          "expedited": "N/A - Post-service",
          "goldCard": "N/A - Federal Medicare",
          "channel": "Claims-based / LCD compliance"
        },
        {
          "name": "Empire BlueCross BlueShield",
          "slug": "EMPIREBCBS",
          "id": "NY-MA-EMPIREBCBS",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "Elevance Health",
          "pbm": null,
          "url": "https://www.empireblue.com/",
          "turnaround": "7 days",
          "expedited": "72 hours",
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Empire BCBS",
          "slug": "EMPIRE",
          "id": "NY-COM-EMPIRE",
          "lob": "COM",
          "lobCode": "COM",
          "parent": null,
          "pbm": null,
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Fidelis Care",
          "slug": "FIDELIS-CLUSTER",
          "id": "NY-MCD-FIDELIS-CLUSTER",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": null,
          "pbm": null,
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "NYRx (Magellan)",
          "slug": "NYRX-CLUSTER",
          "id": "NY-MCD-NYRX-CLUSTER",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": null,
          "pbm": null,
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Highmark Blue Cross Blue Shield of Western New York",
          "slug": "HIGHMARKWNY",
          "id": "NY-COM-HIGHMARKWNY",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "Highmark",
          "pbm": null,
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        }
      ],
      "NC": [
        {
          "name": "Aetna",
          "slug": "AETNA",
          "id": "NC-COM-AETNA",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "CVS Health",
          "pbm": "CVS Caremark",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Ambetter",
          "slug": "AMBET",
          "id": "NC-COM-AMBET",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "Centene",
          "pbm": "Express Scripts",
          "url": "https://www.ambetter.com/",
          "turnaround": "7 calendar days",
          "expedited": "72 hours",
          "goldCard": "HB 434 applies - pending implementation",
          "channel": "CoverMyMeds / Ambetter Portal"
        },
        {
          "name": "Blue Cross Blue Shield of North Carolina",
          "slug": "NCARBCBS",
          "id": "NC-COM-NCARBCBS",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "BCBSNC",
          "pbm": "Prime Therapeutics",
          "url": "https://www.bluecrossnc.com/provider/",
          "turnaround": "7 calendar days",
          "expedited": "72 hours",
          "goldCard": "HB 434 applies - 80% threshold; providers should submit data Q1 2026",
          "channel": "Availity / BCBS NC Portal"
        },
        {
          "name": "Cigna",
          "slug": "CIGNA",
          "id": "NC-COM-CIGNA",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "Cigna",
          "pbm": "Express Scripts",
          "url": "https://www.cigna.com/providers/",
          "turnaround": "7 calendar days",
          "expedited": "72 hours",
          "goldCard": "HB 434 applies - pending implementation",
          "channel": "Cigna Provider Portal"
        },
        {
          "name": "UnitedHealthcare",
          "slug": "UHC",
          "id": "NC-COM-UHC",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "UnitedHealth Group",
          "pbm": "OptumRx",
          "url": "https://www.uhcprovider.com/",
          "turnaround": "7 calendar days",
          "expedited": "72 hours",
          "goldCard": "ACTIVE - 92% threshold; verify status in portal Jan 1 2026",
          "channel": "UHC Provider Portal / Gold Card Status Lookup"
        },
        {
          "name": "Aetna Better Health of North Carolina",
          "slug": "AETNABETTER",
          "id": "NC-MCD-AETNABETTER",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "CVS Health",
          "pbm": "CVS Caremark",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "AmeriHealth Caritas North Carolina",
          "slug": "AMERIHEALTH",
          "id": "NC-MCD-AMERIHEALTH",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "AmeriHealth Caritas",
          "pbm": "CVS Caremark",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Blue Cross Blue Shield of North Dakota",
          "slug": "NDBCBS",
          "id": "NC-MCD-NDBCBS",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "BCBSND",
          "pbm": "Prime Therapeutics",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Carolina Complete Health",
          "slug": "CARCOMPLETE",
          "id": "NC-MCD-CARCOMPLETE",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "Centene",
          "pbm": "Envolve Pharmacy Solutions",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Healthy Blue NC",
          "slug": "HEALTHYBLUE",
          "id": "NC-MCD-HEALTHYBLUE",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "Elevance Health",
          "pbm": "IngenioRx (Carelon)",
          "url": "https://www.healthybluenc.com/providers/",
          "turnaround": "7 calendar days",
          "expedited": "72 hours",
          "goldCard": "HB 434 applies to MCOs",
          "channel": "Healthy Blue Provider Portal"
        },
        {
          "name": "Noridian Mutual Insurance Company",
          "slug": "NORIDIAN",
          "id": "NC-MCD-NORIDIAN",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "Noridian",
          "pbm": "Prime Therapeutics",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Sanford Health Plan",
          "slug": "SANFORD",
          "id": "NC-MCD-SANFORD",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "Sanford Health",
          "pbm": "Express Scripts",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "UnitedHealthcare Community Plan NC",
          "slug": "UHC",
          "id": "NC-MCD-UHC",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "UnitedHealth Group",
          "pbm": "OptumRx",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "WellCare of North Carolina",
          "slug": "WELLCARE",
          "id": "NC-MCD-WELLCARE",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "Centene",
          "pbm": "Envolve Pharmacy Solutions",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Aetna Medicare",
          "slug": "AETNACARE",
          "id": "NC-MA-AETNACARE",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "CVS Health",
          "pbm": "CVS Caremark",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Blue Cross Blue Shield of NC",
          "slug": "NCBCBS",
          "id": "NC-MA-NCBCBS",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "BCBSNC",
          "pbm": "Prime Therapeutics",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Cigna HealthSpring",
          "slug": "CIGNA",
          "id": "NC-MA-CIGNA",
          "lob": "MA",
          "lobCode": "MA",
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          "pbm": "Express Scripts",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Humana",
          "slug": "HUMANA",
          "id": "NC-MA-HUMANA",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "Humana Inc.",
          "pbm": "Humana Pharmacy Solutions",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "UnitedHealthcare",
          "slug": "UHC",
          "id": "NC-MA-UHC",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "UnitedHealth Group",
          "pbm": "OptumRx",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "NC Medicaid (Division of Health Benefits)",
          "slug": "nc-medicaid-dhb",
          "id": "NC-MCD-DHB",
          "lob": "Medicaid Unified PDL",
          "lobCode": "MCD",
          "parent": "NC Dept of Health and Human Services",
          "pbm": "State-managed",
          "url": "https://medicaid.ncdhhs.gov/",
          "turnaround": "7 calendar days",
          "expedited": "72 hours",
          "goldCard": "HB 434 CARE FIRST Act - pending implementation",
          "channel": "GAMMIS / CoverMyMeds"
        },
        {
          "name": "Palmetto GBA (NC)",
          "slug": "palmetto-gba-jm",
          "id": "NC-PARTB-PALMETTO",
          "lob": "PARTB",
          "lobCode": "PARTB",
          "parent": "Palmetto GBA",
          "pbm": "N/A - Medicare",
          "url": "https://www.palmettogba.com/",
          "turnaround": "N/A - LCD determines",
          "expedited": "N/A - LCD determines",
          "goldCard": "N/A - Federal Medicare",
          "channel": "Palmetto eServices"
        },
        {
          "name": "North Carolina NC Health Choice - WellCare",
          "slug": "wellcare-nc-chip",
          "id": "NC-CHIP-WELLCARE",
          "lob": "CHIP",
          "lobCode": "CHIP",
          "parent": "Centene",
          "pbm": "Centene PBM",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "North Carolina NC Health Choice - UnitedHealthcare CP",
          "slug": "uhc-nc-chip",
          "id": "NC-CHIP-UHC",
          "lob": "CHIP",
          "lobCode": "CHIP",
          "parent": "UnitedHealth Group",
          "pbm": "OptumRx",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "North Carolina NC Health Choice - AmeriHealth Caritas",
          "slug": "amerihealth-nc-chip",
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          "lob": "CHIP",
          "lobCode": "CHIP",
          "parent": "AmeriHealth Caritas",
          "pbm": "AmeriHealth PBM",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "North Carolina NC Health Choice - Healthy Blue",
          "slug": "healthyblue-nc-chip",
          "id": "NC-CHIP-HEALTHYBLUE",
          "lob": "CHIP",
          "lobCode": "CHIP",
          "parent": "Elevance Health",
          "pbm": "Elevance PBM",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Palmetto GBA (NC)",
          "slug": "PALMETTO",
          "id": "NC-MAC-PALMETTO",
          "lob": "Medicare MAC",
          "lobCode": "MAC",
          "parent": "Palmetto GBA",
          "pbm": "N/A - Medical Benefit",
          "url": "https://www.palmettogba.com/",
          "turnaround": "N/A - Post-service",
          "expedited": "N/A - Post-service",
          "goldCard": "N/A - Federal Medicare",
          "channel": "Claims-based / LCD compliance"
        },
        {
          "name": "BCBS NC",
          "slug": "BCBSNC",
          "id": "NC-COM-BCBSNC",
          "lob": "COM",
          "lobCode": "COM",
          "parent": null,
          "pbm": null,
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Children and Families Specialty Plan (Healthy Blue Care Together)",
          "slug": "CFSP",
          "id": "NC-MCD-CFSP",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "Blue Cross Blue Shield NC",
          "pbm": null,
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Devoted Health Plan of North Carolina Inc.",
          "slug": "DEVOTED",
          "id": "NC-MA-DEVOTED",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "Devoted Health",
          "pbm": null,
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Alignment Health Plan of North Carolina, Inc.",
          "slug": "ALIGNMENT",
          "id": "NC-MA-ALIGNMENT",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "Alignment Healthcare",
          "pbm": null,
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        }
      ],
      "OH": [
        {
          "name": "Aetna",
          "slug": "AETNA",
          "id": "OH-COM-AETNA",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "CVS Health",
          "pbm": "CVS Caremark",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Cigna",
          "slug": "CIGNA",
          "id": "OH-COM-CIGNA",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "Cigna",
          "pbm": "Express Scripts",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Elevance Health (Anthem)",
          "slug": "ELEV",
          "id": "OH-COM-ELEV",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "Elevance Health",
          "pbm": "IngenioRx (Carelon)",
          "url": "https://www.anthem.com/provider/",
          "turnaround": "7 calendar days",
          "expedited": "72 hours",
          "goldCard": null,
          "channel": "Availity / Anthem Portal"
        },
        {
          "name": "Medical Mutual of Ohio",
          "slug": "MEDMUTUAL",
          "id": "OH-COM-MEDMUTUAL",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "Medical Mutual",
          "pbm": "Express Scripts",
          "url": "https://www.medmutual.com/providers/",
          "turnaround": "7 calendar days",
          "expedited": "72 hours",
          "goldCard": "Investigating",
          "channel": "eviCore/Cohere Portal"
        },
        {
          "name": "Molina Healthcare",
          "slug": "MOLINA",
          "id": "OH-COM-MOLINA",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "Molina Healthcare",
          "pbm": "CVS Caremark",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "UnitedHealthcare",
          "slug": "UHC",
          "id": "OH-COM-UHC",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "UnitedHealth Group",
          "pbm": "OptumRx",
          "url": "https://www.uhcprovider.com/",
          "turnaround": "7 calendar days",
          "expedited": "72 hours",
          "goldCard": "Yes - ACTIVE (Voluntary) since Oct 2024; 92% threshold",
          "channel": "UHC Provider Portal / Link"
        },
        {
          "name": "Aetna Better Health of Ohio",
          "slug": "AETNABETTER",
          "id": "OH-MCD-AETNABETTER",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "CVS Health",
          "pbm": "CVS Caremark",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Buckeye Health Plan",
          "slug": "BUCKEYE",
          "id": "OH-MCD-BUCKEYE",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "Centene",
          "pbm": "Envolve Pharmacy Solutions",
          "url": "https://www.buckeyehealthplan.com/providers/",
          "turnaround": "7 calendar days",
          "expedited": "72 hours",
          "goldCard": "HB 130 (Pending)",
          "channel": "Buckeye Provider Portal"
        },
        {
          "name": "CareSource Ohio",
          "slug": "CARESOURCE",
          "id": "OH-MCD-CARESOURCE",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "CareSource",
          "pbm": "Express Scripts",
          "url": "https://www.caresource.com/providers/",
          "turnaround": "7 calendar days",
          "expedited": "72 hours",
          "goldCard": "HB 130 (Pending)",
          "channel": "CareSource Provider Portal"
        },
        {
          "name": "Molina Healthcare of Ohio",
          "slug": "MOLINA",
          "id": "OH-MCD-MOLINA",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "Molina Healthcare",
          "pbm": "CVS Caremark",
          "url": "https://www.molinahealthcare.com/providers/",
          "turnaround": "7 calendar days",
          "expedited": "72 hours",
          "goldCard": "HB 130 (Pending)",
          "channel": "Molina Provider Portal"
        },
        {
          "name": "Paramount Advantage",
          "slug": "PARAMOUNT",
          "id": "OH-MCD-PARAMOUNT",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "ProMedica",
          "pbm": "Express Scripts",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "UnitedHealthcare Community Plan Ohio",
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          "lobCode": "MCD",
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        },
        {
          "name": "Aetna Medicare",
          "slug": "AETNACARE",
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          "lobCode": "MA",
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        },
        {
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        },
        {
          "name": "Elevance Health (Anthem)",
          "slug": "ELEV",
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          "lobCode": "MA",
          "parent": "Elevance Health",
          "pbm": "IngenioRx (Carelon)",
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        },
        {
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          "slug": "HUMANA",
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        },
        {
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          "lobCode": "MA",
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        {
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        },
        {
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        {
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          "turnaround": "N/A - LCD determines",
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        },
        {
          "name": "Ohio Healthy Start/CHIP - CareSource",
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        {
          "name": "Ohio Healthy Start/CHIP - UnitedHealthcare CP",
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        },
        {
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        {
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        },
        {
          "name": "Anthem Ohio",
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        },
        {
          "name": "Buckeye Health Plan",
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        {
          "name": "Ohio UPDL",
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        },
        {
          "name": "Wellcare Buckeye MyCare Ohio Dual Align (HMO D-SNP)",
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      ],
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        },
        {
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        {
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        {
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        },
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        },
        {
          "name": "SoonerSelect - Oklahoma Complete Health",
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        },
        {
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        {
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        {
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        },
        {
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        },
        {
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        },
        {
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        },
        {
          "name": "Humana",
          "slug": "HUMANA",
          "id": "PA-MA-HUMANA",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "Humana Inc.",
          "pbm": "Humana Pharmacy Solutions",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "UnitedHealthcare",
          "slug": "UHC",
          "id": "PA-MA-UHC",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "UnitedHealth Group",
          "pbm": "OptumRx",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "UPMC Health Plan",
          "slug": "UPMCHEALTH",
          "id": "PA-MA-UPMCHEALTH",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "UPMC",
          "pbm": "CVS Caremark",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Pennsylvania Medicaid FFS",
          "slug": "pa-medicaid-ffs",
          "id": "PA-MCD-FFS",
          "lob": "Medicaid FFS",
          "lobCode": "MCD",
          "parent": "PA Department of Human Services",
          "pbm": "PA DHS",
          "url": "https://www.papdl.com/",
          "turnaround": "7 calendar days",
          "expedited": "72 hours",
          "goldCard": "N/A - Medicaid FFS",
          "channel": "PA DHS PROMISe Portal"
        },
        {
          "name": "Novitas Solutions",
          "slug": "novitas-mac-jl",
          "id": "PA-MAC-NOVITAS",
          "lob": "Medicare MAC",
          "lobCode": "MAC",
          "parent": "First Health Group",
          "pbm": "N/A - Medicare",
          "url": "https://www.novitas-solutions.com/",
          "turnaround": "N/A - LCD determines",
          "expedited": "N/A - LCD determines",
          "goldCard": "N/A - Federal Medicare",
          "channel": "Novitas Medicare Portal"
        },
        {
          "name": "Pennsylvania CHIP - Highmark",
          "slug": "highmark-pa-chip",
          "id": "PA-CHIP-HIGHMARK",
          "lob": "CHIP",
          "lobCode": "CHIP",
          "parent": "Highmark",
          "pbm": "Highmark PBM",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Pennsylvania CHIP - UPMC Health Plan",
          "slug": "upmc-pa-chip",
          "id": "PA-CHIP-UPMC",
          "lob": "CHIP",
          "lobCode": "CHIP",
          "parent": "UPMC",
          "pbm": "UPMC PBM",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Pennsylvania CHIP - Geisinger Health Plan",
          "slug": "geisinger-pa-chip",
          "id": "PA-CHIP-GEISINGER",
          "lob": "CHIP",
          "lobCode": "CHIP",
          "parent": "Geisinger",
          "pbm": "Geisinger PBM",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Pennsylvania CHIP - Aetna Better Health",
          "slug": "aetna-pa-chip",
          "id": "PA-CHIP-AETNA",
          "lob": "CHIP",
          "lobCode": "CHIP",
          "parent": "CVS Health",
          "pbm": "CVS Caremark",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Pennsylvania CHIP - AmeriHealth Caritas",
          "slug": "amerihealth-pa-chip",
          "id": "PA-CHIP-AMERIHEALTH",
          "lob": "CHIP",
          "lobCode": "CHIP",
          "parent": "AmeriHealth Caritas",
          "pbm": "AmeriHealth PBM",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Highmark Blue Cross Blue Shield",
          "slug": "HIGHBCBS-CLUSTER",
          "id": "PA-COM-HIGHBCBS-CLUSTER",
          "lob": "COM",
          "lobCode": "COM",
          "parent": null,
          "pbm": null,
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "PA DHS Medicaid",
          "slug": "PADHS",
          "id": "PA-MCD-PADHS",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": null,
          "pbm": null,
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "WellKids by PA Health & Wellness",
          "slug": "WELLKIDS",
          "id": "PA-CHIP-WELLKIDS",
          "lob": "CHIP",
          "lobCode": "CHIP",
          "parent": "Centene",
          "pbm": null,
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        }
      ],
      "RI": [
        {
          "name": "Aetna",
          "slug": "AETNA",
          "id": "RI-COM-AETNA",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "CVS Health",
          "pbm": "CVS Caremark",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Blue Cross Blue Shield of Rhode Island",
          "slug": "RIBCBS",
          "id": "RI-COM-RIBCBS",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "BCBSRI",
          "pbm": "Prime Therapeutics",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Neighborhood Health Plan of RI",
          "slug": "RINEIGH",
          "id": "RI-COM-RINEIGH",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "Neighborhood Health Plan",
          "pbm": "CVS Caremark",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Tufts Health Plan",
          "slug": "TUFTS",
          "id": "RI-COM-TUFTS",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "Point32Health",
          "pbm": "Express Scripts",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "UnitedHealthcare",
          "slug": "UHC",
          "id": "RI-COM-UHC",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "UnitedHealth Group",
          "pbm": "OptumRx",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Neighborhood Health Plan of RI",
          "slug": "RINEIGH",
          "id": "RI-MCD-RINEIGH",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "Neighborhood Health Plan of RI",
          "pbm": "CVS Caremark",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "UnitedHealthcare Community Plan RI",
          "slug": "UHC",
          "id": "RI-MCD-UHC",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "UnitedHealth Group",
          "pbm": "OptumRx",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Blue Cross Blue Shield of RI",
          "slug": "RIBCBS",
          "id": "RI-MA-RIBCBS",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "BCBSRI",
          "pbm": "Prime Therapeutics",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Humana",
          "slug": "HUMANA",
          "id": "RI-MA-HUMANA",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "Humana Inc.",
          "pbm": "Humana Pharmacy Solutions",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Tufts Health Plan",
          "slug": "TUFTS",
          "id": "RI-MA-TUFTS",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "Point32Health",
          "pbm": "Express Scripts",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "UnitedHealthcare",
          "slug": "UHC",
          "id": "RI-MA-UHC",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "UnitedHealth Group",
          "pbm": "OptumRx",
          "url": "https://www.uhcprovider.com/",
          "turnaround": "Standard",
          "expedited": "Expedited",
          "goldCard": null,
          "channel": "Optum Pro Portal"
        },
        {
          "name": "Blue Cross Blue Shield RI",
          "slug": "bcbsri",
          "id": "RI-COM-BCBSRI",
          "lob": "Commercial",
          "lobCode": "COM",
          "parent": "BCBSRI",
          "pbm": "Prime Therapeutics",
          "url": "https://www.bcbsri.com/",
          "turnaround": "Standard",
          "expedited": "Expedited",
          "goldCard": "⚠️ HB 5120/SB 0168 excludes drugs AND specialists",
          "channel": "BCBSRI Portal"
        },
        {
          "name": "Neighborhood Health Plan RI",
          "slug": "nhpri",
          "id": "RI-MCD-NHPRI",
          "lob": "Medicaid/Exchange",
          "lobCode": "MCD",
          "parent": "NHPRI",
          "pbm": "NHPRI PBM",
          "url": "https://www.nhpri.org/",
          "turnaround": "Standard",
          "expedited": "Expedited",
          "goldCard": "N/A - Medicaid",
          "channel": "NHPRI Portal"
        },
        {
          "name": "Point32Health Rhode Island",
          "slug": "point32-ri",
          "id": "RI-COM-POINT32",
          "lob": "Commercial",
          "lobCode": "COM",
          "parent": "Point32Health",
          "pbm": "Point32 PBM",
          "url": "https://www.point32health.org/",
          "turnaround": "Standard",
          "expedited": "Expedited",
          "goldCard": null,
          "channel": "Point32 Portal"
        },
        {
          "name": "National Government Services (RI)",
          "slug": "ngs-jk-ri",
          "id": "RI-PARTB-NGS",
          "lob": "PARTB",
          "lobCode": "PARTB",
          "parent": "NGS",
          "pbm": null,
          "url": "https://www.ngsmedicare.com/",
          "turnaround": "LCD",
          "expedited": null,
          "goldCard": "N/A - Federal",
          "channel": "NGS Portal"
        },
        {
          "name": "Rhode Island RIte Care Kids - Neighborhood Health Plan",
          "slug": "nhpri-ri-chip",
          "id": "RI-CHIP-NHPRI",
          "lob": "CHIP",
          "lobCode": "CHIP",
          "parent": "Neighborhood Health Plan",
          "pbm": "NHPRI PBM",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Rhode Island RIte Care Kids - UnitedHealthcare CP",
          "slug": "uhc-ri-chip",
          "id": "RI-CHIP-UHC",
          "lob": "CHIP",
          "lobCode": "CHIP",
          "parent": "UnitedHealth Group",
          "pbm": "OptumRx",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Novitas Solutions (RI)",
          "slug": "NOVITAS",
          "id": "RI-MAC-NOVITAS",
          "lob": "Medicare MAC",
          "lobCode": "MAC",
          "parent": "Novitas",
          "pbm": "N/A - Medical Benefit",
          "url": "https://www.novitas-solutions.com/",
          "turnaround": "N/A - Post-service",
          "expedited": "N/A - Post-service",
          "goldCard": "N/A - Federal Medicare",
          "channel": "Claims-based / LCD compliance"
        },
        {
          "name": "National Government Services (RI)",
          "slug": "NGS",
          "id": "RI-MAC-NGS",
          "lob": "Medicare MAC",
          "lobCode": "MAC",
          "parent": "NGS",
          "pbm": "N/A - Medical Benefit",
          "url": "https://www.ngsmedicare.com/",
          "turnaround": "N/A - Post-service",
          "expedited": "N/A - Post-service",
          "goldCard": "N/A - Federal Medicare",
          "channel": "Claims-based / LCD compliance"
        },
        {
          "name": "Neighborhood Health Plan of RI Dual CONNECT / INTEGRITY",
          "slug": "NHPRI",
          "id": "RI-MA-NHPRI",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "Neighborhood Health Plan of RI",
          "pbm": null,
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        }
      ],
      "SC": [
        {
          "name": "Aetna",
          "slug": "AETNA",
          "id": "SC-COM-AETNA",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "CVS Health",
          "pbm": "CVS Caremark",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Ambetter",
          "slug": "AMBET",
          "id": "SC-COM-AMBET",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "Centene",
          "pbm": "Express Scripts",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Blue Cross Blue Shield of South Carolina",
          "slug": "SCARBCBS",
          "id": "SC-COM-SCARBCBS",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "BlueCross BlueShield of SC",
          "pbm": "Prime Therapeutics",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Cigna",
          "slug": "CIGNA",
          "id": "SC-COM-CIGNA",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "Cigna",
          "pbm": "Express Scripts",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "UnitedHealthcare",
          "slug": "UHC",
          "id": "SC-COM-UHC",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "UnitedHealth Group",
          "pbm": "OptumRx",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Absolute Total Care",
          "slug": "ABSOLUTE",
          "id": "SC-MCD-ABSOLUTE",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "Centene",
          "pbm": "Envolve Pharmacy Solutions",
          "url": "https://www.absolutetotalcare.com/",
          "turnaround": "Standard",
          "expedited": "Expedited",
          "goldCard": "N/A - Medicaid",
          "channel": "Centene Portal"
        },
        {
          "name": "Healthy Blue SC",
          "slug": "HEALTHYBLUE",
          "id": "SC-MCD-HEALTHYBLUE",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "Elevance Health",
          "pbm": "IngenioRx (Carelon)",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Molina Healthcare of South Carolina",
          "slug": "MOLINA",
          "id": "SC-MCD-MOLINA",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "Molina Healthcare",
          "pbm": "CVS Caremark",
          "url": "https://www.molinahealthcare.com/",
          "turnaround": "Standard",
          "expedited": "Expedited",
          "goldCard": "N/A - Medicaid",
          "channel": "Availity"
        },
        {
          "name": "Select Health of South Carolina",
          "slug": "SELECTSC",
          "id": "SC-MCD-SELECTSC",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "AmeriHealth Caritas",
          "pbm": "CVS Caremark",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Aetna Medicare",
          "slug": "AETNACARE",
          "id": "SC-MA-AETNACARE",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "CVS Health",
          "pbm": "CVS Caremark",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Blue Cross Blue Shield of SC",
          "slug": "SCBCBS",
          "id": "SC-MA-SCBCBS",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "BlueCross BlueShield of SC",
          "pbm": "Prime Therapeutics",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Humana",
          "slug": "HUMANA",
          "id": "SC-MA-HUMANA",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "Humana Inc.",
          "pbm": "Humana Pharmacy Solutions",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Molina Healthcare",
          "slug": "MOLINA",
          "id": "SC-MA-MOLINA",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "Molina Healthcare",
          "pbm": "CVS Caremark",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "UnitedHealthcare",
          "slug": "UHC",
          "id": "SC-MA-UHC",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "UnitedHealth Group",
          "pbm": "OptumRx",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "BlueCross BlueShield SC",
          "slug": "bcbssc-sc",
          "id": "SC-COM-BCBSSC",
          "lob": "Commercial",
          "lobCode": "COM",
          "parent": "BCBSSC",
          "pbm": "Prime Therapeutics/CVS Caremark",
          "url": "https://www.bcbssc.com/",
          "turnaround": "Standard",
          "expedited": "Expedited",
          "goldCard": "⚠️ S. 531 pending - no state mandate yet",
          "channel": "BCBSSC Portal"
        },
        {
          "name": "SC Medicaid (SCDHHS)",
          "slug": "sc-medicaid",
          "id": "SC-MCD-SCDHHS",
          "lob": "Medicaid FFS",
          "lobCode": "MCD",
          "parent": "SCDHHS",
          "pbm": "Magellan Rx",
          "url": "https://www.scdhhs.gov/",
          "turnaround": "Standard",
          "expedited": "Expedited",
          "goldCard": "N/A - Medicaid",
          "channel": "SCDHHS Portal"
        },
        {
          "name": "First Choice SC",
          "slug": "first-choice-sc",
          "id": "SC-MCD-FIRSTCHOICE",
          "lob": "Medicaid MCO",
          "lobCode": "MCD",
          "parent": "AmeriHealth Caritas",
          "pbm": "AmeriHealth PBM",
          "url": "https://www.firstchoicesc.com/",
          "turnaround": "Standard",
          "expedited": "Expedited",
          "goldCard": "N/A - Medicaid",
          "channel": "NaviNet"
        },
        {
          "name": "Palmetto GBA (SC)",
          "slug": "palmetto-jjm-sc",
          "id": "SC-PARTB-PALMETTO",
          "lob": "PARTB",
          "lobCode": "PARTB",
          "parent": "Palmetto GBA",
          "pbm": null,
          "url": "https://www.palmettogba.com/",
          "turnaround": "LCD",
          "expedited": null,
          "goldCard": "N/A - Federal",
          "channel": "Palmetto Portal"
        },
        {
          "name": "South Carolina Healthy Connections Kids - Select Health",
          "slug": "selecthealth-sc-chip",
          "id": "SC-CHIP-SELECTHEALTH",
          "lob": "CHIP",
          "lobCode": "CHIP",
          "parent": "AmeriHealth",
          "pbm": "AmeriHealth PBM",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "South Carolina Healthy Connections Kids - Molina",
          "slug": "molina-sc-chip",
          "id": "SC-CHIP-MOLINA",
          "lob": "CHIP",
          "lobCode": "CHIP",
          "parent": "Molina Healthcare",
          "pbm": "CVS Caremark",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Palmetto GBA (SC)",
          "slug": "PALMETTO",
          "id": "SC-MAC-PALMETTO",
          "lob": "Medicare MAC",
          "lobCode": "MAC",
          "parent": "Palmetto GBA",
          "pbm": "N/A - Medical Benefit",
          "url": "https://www.palmettogba.com/",
          "turnaround": "N/A - Post-service",
          "expedited": "N/A - Post-service",
          "goldCard": "N/A - Federal Medicare",
          "channel": "Claims-based / LCD compliance"
        },
        {
          "name": "SC Public Employee Benefit Authority (State Health Plan)",
          "slug": "PEBA",
          "id": "SC-COM-PEBA",
          "lob": "COM",
          "lobCode": "COM",
          "parent": null,
          "pbm": null,
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Wellcare Absolute Total Care Dual Align (HMO D-SNP)",
          "slug": "WELLCARE",
          "id": "SC-MA-WELLCARE",
          "lob": "MA",
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      ],
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        {
          "name": "Aetna",
          "slug": "AETNA",
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          "lob": "COM",
          "lobCode": "COM",
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        },
        {
          "name": "Ambetter",
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        },
        {
          "name": "Blue Cross Blue Shield of Tennessee",
          "slug": "TENBCBS",
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        {
          "name": "Cigna",
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          "lobCode": "COM",
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          "url": "https://www.cigna.com/",
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          "channel": "Cigna Portal"
        },
        {
          "name": "UnitedHealthcare",
          "slug": "UHC",
          "id": "TN-COM-UHC",
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          "lobCode": "COM",
          "parent": "UnitedHealth Group",
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        },
        {
          "name": "Amerigroup Tennessee",
          "slug": "AMERIGROUP",
          "id": "TN-MCD-AMERIGROUP",
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          "lobCode": "MCD",
          "parent": "Elevance Health",
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        },
        {
          "name": "BlueCare Tennessee",
          "slug": "TNBLUECARE",
          "id": "TN-MCD-TNBLUECARE",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "BlueCross BlueShield of Tennessee",
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        },
        {
          "name": "TennCare Select",
          "slug": "TENNCARE",
          "id": "TN-MCD-TENNCARE",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "BlueCross BlueShield of Tennessee",
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        },
        {
          "name": "UnitedHealthcare Community Plan TN",
          "slug": "UHC",
          "id": "TN-MCD-UHC",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "UnitedHealth Group",
          "pbm": "OptumRx",
          "url": "https://www.uhcprovider.com/",
          "turnaround": "7 days",
          "expedited": "72 hours",
          "goldCard": "✓ National Gold Card 92%",
          "channel": "UHC Portal"
        },
        {
          "name": "Aetna Medicare",
          "slug": "AETNACARE",
          "id": "TN-MA-AETNACARE",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "CVS Health",
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        },
        {
          "name": "BlueCross BlueShield of Tennessee",
          "slug": "TNBCBS",
          "id": "TN-MA-TNBCBS",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "BCBST",
          "pbm": "Prime Therapeutics",
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        },
        {
          "name": "Cigna HealthSpring",
          "slug": "CIGNA",
          "id": "TN-MA-CIGNA",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "Cigna",
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        },
        {
          "name": "Humana",
          "slug": "HUMANA",
          "id": "TN-MA-HUMANA",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "Humana Inc.",
          "pbm": "Humana Pharmacy Solutions",
          "url": null,
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        },
        {
          "name": "UnitedHealthcare",
          "slug": "UHC",
          "id": "TN-MA-UHC",
          "lob": "MA",
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          "parent": "UnitedHealth Group",
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        },
        {
          "name": "BlueCross BlueShield Tennessee",
          "slug": "bcbst-tn",
          "id": "TN-COM-BCBST",
          "lob": "Commercial",
          "lobCode": "COM",
          "parent": "BCBST",
          "pbm": "BCBST PBM",
          "url": "https://www.bcbst.com/",
          "turnaround": "Standard",
          "expedited": "Expedited",
          "goldCard": "⚠️ No state mandate - HB 869 = API/transparency focus",
          "channel": "BCBST Portal"
        },
        {
          "name": "Wellpoint Tennessee (TennCare)",
          "slug": "wellpoint-tn",
          "id": "TN-MCD-WELLPOINT",
          "lob": "Medicaid MCO",
          "lobCode": "MCD",
          "parent": "Elevance Health",
          "pbm": "Carelon/OptumRx",
          "url": "https://www.wellpoint.com/",
          "turnaround": "7 days (CMS Rule)",
          "expedited": "72 hours",
          "goldCard": "N/A - Medicaid",
          "channel": "Wellpoint Portal"
        },
        {
          "name": "BlueCare Tennessee (TennCare)",
          "slug": "bluecare-tn",
          "id": "TN-MCD-BLUECARE",
          "lob": "Medicaid MCO",
          "lobCode": "MCD",
          "parent": "BCBST",
          "pbm": "CVS Caremark/OptumRx",
          "url": "https://www.bluecaretn.com/",
          "turnaround": "7 days",
          "expedited": "72 hours",
          "goldCard": "N/A - Medicaid",
          "channel": "BCBST Portal"
        },
        {
          "name": "Palmetto GBA (TN)",
          "slug": "palmetto-jm-tn",
          "id": "TN-PARTB-PALMETTO",
          "lob": "PARTB",
          "lobCode": "PARTB",
          "parent": "Palmetto GBA",
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          "url": "https://www.palmettogba.com/",
          "turnaround": "LCD",
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          "goldCard": "N/A - Federal",
          "channel": "Palmetto Portal"
        },
        {
          "name": "Tennessee CoverKids - BlueCare",
          "slug": "bluecare-tn-chip",
          "id": "TN-CHIP-BLUECARE",
          "lob": "CHIP",
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          "channel": null
        },
        {
          "name": "Tennessee CoverKids - Amerigroup",
          "slug": "amerigroup-tn-chip",
          "id": "TN-CHIP-AMERIGROUP",
          "lob": "CHIP",
          "lobCode": "CHIP",
          "parent": "Elevance Health",
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          "goldCard": null,
          "channel": null
        },
        {
          "name": "Tennessee CoverKids - UnitedHealthcare CP",
          "slug": "uhc-tn-chip",
          "id": "TN-CHIP-UHC",
          "lob": "CHIP",
          "lobCode": "CHIP",
          "parent": "UnitedHealth Group",
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          "url": null,
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          "channel": null
        },
        {
          "name": "Palmetto GBA (TN)",
          "slug": "PALMETTO",
          "id": "TN-MAC-PALMETTO",
          "lob": "Medicare MAC",
          "lobCode": "MAC",
          "parent": "Palmetto GBA",
          "pbm": "N/A - Medical Benefit",
          "url": "https://www.palmettogba.com/",
          "turnaround": "N/A - Post-service",
          "expedited": "N/A - Post-service",
          "goldCard": "N/A - Federal Medicare",
          "channel": "Claims-based / LCD compliance"
        }
      ],
      "TX": [
        {
          "name": "Aetna",
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        },
        {
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          "lob": "COM",
          "lobCode": "COM",
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          "url": "https://www.ambetterhealth.com/content/dam/centene/Superior/Ambetter/PDFs/SHP_202310184-HB3459-Provider-FAQ-P-508.pdf",
          "turnaround": "7 days",
          "expedited": "72 hours",
          "goldCard": "HB 3459 applies to fully insured TDI plans",
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        },
        {
          "name": "Cigna",
          "slug": "CIGNA",
          "id": "TX-COM-CIGNA",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "Cigna",
          "pbm": "Express Scripts",
          "url": "https://www.cigna.com/static/www-cigna-com/docs/texas-prior-authorization-exemption-legislation-faqs.pdf",
          "turnaround": "7 days",
          "expedited": "72 hours",
          "goldCard": "TX HB 3459 - biannual notifications",
          "channel": "Portal"
        },
        {
          "name": "Health Care Service Corp. (BCBSTX)",
          "slug": "BCBSTX",
          "id": "TX-COM-BCBSTX",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "HCSC",
          "pbm": "Prime Therapeutics",
          "url": "https://www.bcbstx.com/provider/claims/claims-eligibility/um/pa-exemptions",
          "turnaround": "7 days",
          "expedited": "72 hours",
          "goldCard": "HB 3459/HB 3812 - 90% threshold; 5+ requests; annual evaluation",
          "channel": "Portal (Availity)"
        },
        {
          "name": "Oscar Health",
          "slug": "OSCAR",
          "id": "TX-COM-OSCAR",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "Oscar Health",
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          "url": null,
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          "channel": null
        },
        {
          "name": "UnitedHealthcare",
          "slug": "UHC",
          "id": "TX-COM-UHC",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "UnitedHealth Group",
          "pbm": "OptumRx",
          "url": "https://www.uhcprovider.com/content/dam/provider/docs/public/health-plans/tx-commercial-gold-card-faq.pdf",
          "turnaround": "7 days",
          "expedited": "72 hours",
          "goldCard": "TX Gold Card - annual evaluation Jan-Dec",
          "channel": "Portal (SmartPA)"
        },
        {
          "name": "Aetna Better Health of Texas",
          "slug": "AETNABETTER",
          "id": "TX-MCD-AETNABETTER",
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          "lobCode": "MCD",
          "parent": "CVS Health",
          "pbm": "CVS Caremark",
          "url": null,
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          "channel": null
        },
        {
          "name": "Amerigroup Texas",
          "slug": "AMERIGROUP",
          "id": "TX-MCD-AMERIGROUP",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "Elevance Health",
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          "url": null,
          "turnaround": null,
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          "goldCard": null,
          "channel": null
        },
        {
          "name": "Community Health Choice",
          "slug": "COMMCHOICE",
          "id": "TX-MCD-COMMCHOICE",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "Community Health Choice",
          "pbm": "Express Scripts",
          "url": null,
          "turnaround": null,
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          "channel": null
        },
        {
          "name": "Dell Children's Health Plan",
          "slug": "DELLCHILD",
          "id": "TX-MCD-DELLCHILD",
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          "lobCode": "MCD",
          "parent": "Seton Healthcare Family",
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          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Driscoll Health Plan",
          "slug": "DRISCOLL",
          "id": "TX-MCD-DRISCOLL",
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          "lobCode": "MCD",
          "parent": "Driscoll Health",
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          "url": null,
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          "channel": null
        },
        {
          "name": "El Paso Health",
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          "lobCode": "MCD",
          "parent": "El Paso County Hospital District",
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          "url": null,
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        },
        {
          "name": "Molina Healthcare of Texas",
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          "lobCode": "MCD",
          "parent": "Molina Healthcare",
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          "url": null,
          "turnaround": null,
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          "goldCard": null,
          "channel": null
        },
        {
          "name": "Parkland Community Health Plan",
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          "lobCode": "MCD",
          "parent": "Dallas County Hospital District",
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          "url": null,
          "turnaround": null,
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          "goldCard": null,
          "channel": null
        },
        {
          "name": "Superior HealthPlan",
          "slug": "SUPERIOR",
          "id": "TX-MCD-SUPERIOR",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "Centene",
          "pbm": "Envolve Pharmacy Solutions",
          "url": "https://www.superiorhealthplan.com/providers/resources/clinical-payment-policies.html",
          "turnaround": "7 days",
          "expedited": "72 hours",
          "goldCard": "N/A - Medicaid excluded from HB 3459",
          "channel": "Portal"
        },
        {
          "name": "Texas Children's Health Plan",
          "slug": "TXCHILD",
          "id": "TX-MCD-TXCHILD",
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          "lobCode": "MCD",
          "parent": "Texas Children's Hospital",
          "pbm": "Express Scripts",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "UnitedHealthcare Community Plan TX",
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          "id": "TX-MCD-UHC",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "UnitedHealth Group",
          "pbm": "OptumRx",
          "url": "https://www.uhcprovider.com/content/dam/provider/docs/public/resources/pharmacy/Community-Plan-Q1-2026-PDL-Updates.pdf",
          "turnaround": "7 days",
          "expedited": "72 hours",
          "goldCard": "N/A - Medicaid excluded from HB 3459",
          "channel": "Portal (SmartPA)"
        },
        {
          "name": "Aetna Medicare",
          "slug": "AETNACARE",
          "id": "TX-MA-AETNACARE",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "CVS Health",
          "pbm": "CVS Caremark",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Blue Cross Blue Shield of Texas",
          "slug": "TXBCBS",
          "id": "TX-MA-TXBCBS",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "HCSC",
          "pbm": "Prime Therapeutics",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Cigna HealthSpring",
          "slug": "CIGNA",
          "id": "TX-MA-CIGNA",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "Cigna",
          "pbm": "Express Scripts",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Humana",
          "slug": "HUMANA",
          "id": "TX-MA-HUMANA",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "Humana Inc.",
          "pbm": "Humana Pharmacy Solutions",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "UnitedHealthcare",
          "slug": "UHC",
          "id": "TX-MA-UHC",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "UnitedHealth Group",
          "pbm": "OptumRx",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Novitas Solutions",
          "slug": "NOVITAS",
          "id": "TX-PARTB-NOVITAS",
          "lob": "PARTB",
          "lobCode": "PARTB",
          "parent": "Novitas Solutions (Jurisdiction H MAC)",
          "pbm": null,
          "url": "https://www.novitas-solutions.com/webcenter/portal/MedicareJL/pagebyid?contentId=00307990",
          "turnaround": "7 days",
          "expedited": "72 hours",
          "goldCard": "N/A - Federal Medicare not subject to state Gold Card",
          "channel": "Portal"
        },
        {
          "name": "Texas Children's Medicaid/CHIP - Superior HealthPlan",
          "slug": "superior-tx-chip",
          "id": "TX-CHIP-SUPERIOR",
          "lob": "CHIP",
          "lobCode": "CHIP",
          "parent": "Centene",
          "pbm": "Centene PBM",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Texas Children's Medicaid/CHIP - UnitedHealthcare CP",
          "slug": "uhc-tx-chip",
          "id": "TX-CHIP-UHC",
          "lob": "CHIP",
          "lobCode": "CHIP",
          "parent": "UnitedHealth Group",
          "pbm": "OptumRx",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Texas Children's Medicaid/CHIP - Molina",
          "slug": "molina-tx-chip",
          "id": "TX-CHIP-MOLINA",
          "lob": "CHIP",
          "lobCode": "CHIP",
          "parent": "Molina Healthcare",
          "pbm": "CVS Caremark",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Texas Children's Medicaid/CHIP - Amerigroup",
          "slug": "amerigroup-tx-chip",
          "id": "TX-CHIP-AMERIGROUP",
          "lob": "CHIP",
          "lobCode": "CHIP",
          "parent": "Elevance Health",
          "pbm": "Elevance PBM",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Texas Children's Medicaid/CHIP - BCBSTX",
          "slug": "bcbstx-chip",
          "id": "TX-CHIP-BCBSTX",
          "lob": "CHIP",
          "lobCode": "CHIP",
          "parent": "HCSC",
          "pbm": "Prime Therapeutics",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Novitas Solutions (TX)",
          "slug": "NOVITAS",
          "id": "TX-MAC-NOVITAS",
          "lob": "Medicare MAC",
          "lobCode": "MAC",
          "parent": "Novitas",
          "pbm": "N/A - Medical Benefit",
          "url": "https://www.novitas-solutions.com/",
          "turnaround": "N/A - Post-service",
          "expedited": "N/A - Post-service",
          "goldCard": "N/A - Federal Medicare",
          "channel": "Claims-based / LCD compliance"
        },
        {
          "name": "TXMEDICAID",
          "slug": null,
          "id": "TX-MCD-TXMEDICAID",
          "lob": "MCD",
          "lobCode": null,
          "parent": null,
          "pbm": null,
          "url": null,
          "turnaround": null,
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          "goldCard": null,
          "channel": null
        },
        {
          "name": "Ambetter",
          "slug": "AMBETTER",
          "id": "TX-ACA-AMBETTER",
          "lob": "ACA",
          "lobCode": "ACA",
          "parent": null,
          "pbm": null,
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Texas Medicaid",
          "slug": "TXMEDICAID-CLUSTER",
          "id": "TX-MCD-TXMEDICAID-CLUSTER",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": null,
          "pbm": null,
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        }
      ],
      "VA": [
        {
          "name": "Aetna",
          "slug": "AETNA",
          "id": "VA-COM-AETNA",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "CVS Health",
          "pbm": "CVS Caremark",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Cigna",
          "slug": "CIGNA",
          "id": "VA-COM-CIGNA",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "Cigna",
          "pbm": "Express Scripts",
          "url": "https://www.cigna.com/providers/",
          "turnaround": "7 calendar days",
          "expedited": "72 hours",
          "goldCard": "HB 2099 Gold Card - DATA COLLECTION 2026",
          "channel": "Cigna Provider Portal"
        },
        {
          "name": "Elevance Health (Anthem)",
          "slug": "ELEV",
          "id": "VA-COM-ELEV",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "Elevance Health",
          "pbm": "IngenioRx (Carelon)",
          "url": "https://www.anthem.com/provider/",
          "turnaround": "7 calendar days",
          "expedited": "72 hours",
          "goldCard": "HB 2099 Gold Card - DATA COLLECTION 2026 (exemptions begin Jan 1 2027); 90% threshold",
          "channel": "Availity / Anthem Portal"
        },
        {
          "name": "Kaiser Permanente",
          "slug": "KAISER",
          "id": "VA-COM-KAISER",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "Kaiser Foundation Health Plan",
          "pbm": "Kaiser Permanente (Internal)/MedImpact",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Oscar Health",
          "slug": "OSCAR",
          "id": "VA-COM-OSCAR",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "Oscar Health",
          "pbm": "Express Scripts",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "UnitedHealthcare",
          "slug": "UHC",
          "id": "VA-COM-UHC",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "UnitedHealth Group",
          "pbm": "OptumRx",
          "url": "https://www.uhcprovider.com/",
          "turnaround": "7 calendar days",
          "expedited": "72 hours",
          "goldCard": "UHC National Gold Card ACTIVE",
          "channel": "UHC Provider Portal / OptumRx"
        },
        {
          "name": "Aetna Better Health of Virginia",
          "slug": "AETNABETTER",
          "id": "VA-MCD-AETNABETTER",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "CVS Health",
          "pbm": "CVS Caremark",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Anthem HealthKeepers Plus",
          "slug": "ANTHEM",
          "id": "VA-MCD-ANTHEM",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "Elevance Health",
          "pbm": "IngenioRx (Carelon)",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Magellan Complete Care of Virginia",
          "slug": "MAGELLAN",
          "id": "VA-MCD-MAGELLAN",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "Molina Healthcare",
          "pbm": "CVS Caremark",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Molina Healthcare of Virginia",
          "slug": "MOLINA",
          "id": "VA-MCD-MOLINA",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "Molina Healthcare",
          "pbm": "CVS Caremark",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Optima Health",
          "slug": "OPTIMA",
          "id": "VA-MCD-OPTIMA",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "Sentara Healthcare",
          "pbm": "Express Scripts",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "UnitedHealthcare Community Plan VA",
          "slug": "UHC",
          "id": "VA-MCD-UHC",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "UnitedHealth Group",
          "pbm": "OptumRx",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Virginia Premier",
          "slug": "VIRGINIAP",
          "id": "VA-MCD-VIRGINIAP",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "Virginia Premier",
          "pbm": "CVS Caremark",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Aetna Medicare",
          "slug": "AETNACARE",
          "id": "VA-MA-AETNACARE",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "CVS Health",
          "pbm": "CVS Caremark",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Anthem (Elevance)",
          "slug": "ELEV",
          "id": "VA-MA-ELEV",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "Elevance Health",
          "pbm": "IngenioRx (Carelon)",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Humana",
          "slug": "HUMANA",
          "id": "VA-MA-HUMANA",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "Humana Inc.",
          "pbm": "Humana Pharmacy Solutions",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Kaiser Permanente",
          "slug": "KAISER",
          "id": "VA-MA-KAISER",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "Kaiser Foundation Health Plan",
          "pbm": "Kaiser Permanente (Internal)/MedImpact",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "UnitedHealthcare",
          "slug": "UHC",
          "id": "VA-MA-UHC",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "UnitedHealth Group",
          "pbm": "OptumRx",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Sentara Health Plans",
          "slug": "sentara-health-plans",
          "id": "VA-COM-SENTARA",
          "lob": "Commercial",
          "lobCode": "COM",
          "parent": "Sentara Healthcare",
          "pbm": "Sentara PBM",
          "url": "https://www.sentara.com/healthplans/",
          "turnaround": "7 calendar days",
          "expedited": "72 hours",
          "goldCard": "HB 2099 Gold Card - DATA COLLECTION 2026",
          "channel": "Sentara Provider Portal"
        },
        {
          "name": "Cardinal Care (VA Medicaid)",
          "slug": "cardinal-care-va",
          "id": "VA-MCD-CARDINAL",
          "lob": "Medicaid Unified",
          "lobCode": "MCD",
          "parent": "VA Dept of Medical Assistance Services",
          "pbm": "State-managed",
          "url": "https://www.dmas.virginia.gov/",
          "turnaround": "7 calendar days",
          "expedited": "72 hours",
          "goldCard": "N/A - Medicaid",
          "channel": "Medicaid Portal"
        },
        {
          "name": "Palmetto GBA (VA)",
          "slug": "palmetto-gba-jm-va",
          "id": "VA-PARTB-PALMETTO",
          "lob": "PARTB",
          "lobCode": "PARTB",
          "parent": "Palmetto GBA",
          "pbm": "N/A - Medicare",
          "url": "https://www.palmettogba.com/",
          "turnaround": "N/A - LCD determines",
          "expedited": null,
          "goldCard": "N/A - Federal Medicare",
          "channel": "Palmetto eServices"
        },
        {
          "name": "Humana Healthy Horizons VA",
          "slug": "humana-healthy-horizons-va",
          "id": "VA-MCD-HUMANA",
          "lob": "Medicaid MCO",
          "lobCode": "MCD",
          "parent": "Humana",
          "pbm": "Humana Pharmacy",
          "url": "https://www.humana.com/provider/",
          "turnaround": "7 calendar days",
          "expedited": "72 hours",
          "goldCard": "N/A - Medicaid",
          "channel": "Humana Provider Portal"
        },
        {
          "name": "Virginia FAMIS - Anthem Healthkeepers",
          "slug": "anthem-va-chip",
          "id": "VA-CHIP-ANTHEM",
          "lob": "CHIP",
          "lobCode": "CHIP",
          "parent": "Elevance Health",
          "pbm": "Elevance PBM",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Virginia FAMIS - Aetna Better Health",
          "slug": "aetna-va-chip",
          "id": "VA-CHIP-AETNA",
          "lob": "CHIP",
          "lobCode": "CHIP",
          "parent": "CVS Health",
          "pbm": "CVS Caremark",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Virginia FAMIS - Molina",
          "slug": "molina-va-chip",
          "id": "VA-CHIP-MOLINA",
          "lob": "CHIP",
          "lobCode": "CHIP",
          "parent": "Molina Healthcare",
          "pbm": "CVS Caremark",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Virginia FAMIS - UnitedHealthcare CP",
          "slug": "uhc-va-chip",
          "id": "VA-CHIP-UHC",
          "lob": "CHIP",
          "lobCode": "CHIP",
          "parent": "UnitedHealth Group",
          "pbm": "OptumRx",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Palmetto GBA (VA)",
          "slug": "PALMETTO",
          "id": "VA-MAC-PALMETTO",
          "lob": "Medicare MAC",
          "lobCode": "MAC",
          "parent": "Palmetto GBA",
          "pbm": "N/A - Medical Benefit",
          "url": "https://www.palmettogba.com/",
          "turnaround": "N/A - Post-service",
          "expedited": "N/A - Post-service",
          "goldCard": "N/A - Federal Medicare",
          "channel": "Claims-based / LCD compliance"
        },
        {
          "name": "ANTHEM",
          "slug": null,
          "id": "VA-COM-ANTHEM",
          "lob": "COM",
          "lobCode": null,
          "parent": null,
          "pbm": null,
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Anthem HealthKeepers",
          "slug": "ANTHEM-CLUSTER",
          "id": "VA-COM-ANTHEM-CLUSTER",
          "lob": "COM",
          "lobCode": "COM",
          "parent": null,
          "pbm": null,
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Sentara Community Plan",
          "slug": "SENTARA",
          "id": "VA-MCD-SENTARA",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "Sentara Healthcare",
          "pbm": null,
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        }
      ],
      "WA": [
        {
          "name": "Aetna",
          "slug": "AETNA",
          "id": "WA-COM-AETNA",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "CVS Health",
          "pbm": "CVS Caremark",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Kaiser Permanente",
          "slug": "KAISER",
          "id": "WA-COM-KAISER",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "Kaiser Foundation Health Plan",
          "pbm": "Kaiser Permanente (Internal)/MedImpact",
          "url": "https://wa-provider.kaiserpermanente.org/",
          "turnaround": "Internal system",
          "expedited": "Internal",
          "goldCard": "NO Gold Card - SB 5395 FAILED",
          "channel": "Kaiser Internal System"
        },
        {
          "name": "Molina Healthcare",
          "slug": "MOLINA",
          "id": "WA-COM-MOLINA",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "Molina Healthcare",
          "pbm": "CVS Caremark",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Premera Blue Cross",
          "slug": "PREMBC",
          "id": "WA-COM-PREMBC",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "Premera Blue Cross",
          "pbm": "Prime Therapeutics",
          "url": "https://www.premera.com/providers/",
          "turnaround": "3 calendar days (ePA mandate)",
          "expedited": "1 calendar day",
          "goldCard": "NO Gold Card - SB 5395 FAILED",
          "channel": "Premera Provider Portal / ePA"
        },
        {
          "name": "Regence BlueShield",
          "slug": "REGENCE",
          "id": "WA-COM-REGENCE",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "Cambia Health Solutions",
          "pbm": "Prime Therapeutics",
          "url": "https://www.regence.com/provider/",
          "turnaround": "3 calendar days (ePA mandate)",
          "expedited": "1 calendar day",
          "goldCard": "NO Gold Card - SB 5395 FAILED",
          "channel": "Regence Provider Portal / ePA"
        },
        {
          "name": "UnitedHealthcare",
          "slug": "UHC",
          "id": "WA-COM-UHC",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "UnitedHealth Group",
          "pbm": "OptumRx",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Amerigroup Washington",
          "slug": "AMERIGROUP",
          "id": "WA-MCD-AMERIGROUP",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "Elevance Health",
          "pbm": "IngenioRx (Carelon)",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Community Health Plan of Washington",
          "slug": "COMMUNWA",
          "id": "WA-MCD-COMMUNWA",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "Community Health Plan of WA",
          "pbm": "Express Scripts",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Coordinated Care",
          "slug": "COORDCARE",
          "id": "WA-MCD-COORDCARE",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "Centene",
          "pbm": "Envolve Pharmacy Solutions",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Kaiser Foundation Health Plan WA",
          "slug": "KAISER",
          "id": "WA-MCD-KAISER",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "Kaiser Permanente",
          "pbm": "Kaiser Permanente (Internal)",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Molina Healthcare of Washington",
          "slug": "MOLINA",
          "id": "WA-MCD-MOLINA",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "Molina Healthcare",
          "pbm": "CVS Caremark",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "UnitedHealthcare Community Plan WA",
          "slug": "UHC",
          "id": "WA-MCD-UHC",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "UnitedHealth Group",
          "pbm": "OptumRx",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Aetna Medicare",
          "slug": "AETNACARE",
          "id": "WA-MA-AETNACARE",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "CVS Health",
          "pbm": "CVS Caremark",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Humana",
          "slug": "HUMANA",
          "id": "WA-MA-HUMANA",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "Humana Inc.",
          "pbm": "Humana Pharmacy Solutions",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Kaiser Permanente",
          "slug": "KAISER",
          "id": "WA-MA-KAISER",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "Kaiser Foundation Health Plan",
          "pbm": "Kaiser Permanente (Internal)/MedImpact",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Premera Blue Cross",
          "slug": "PREMERA",
          "id": "WA-MA-PREMERA",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "Premera",
          "pbm": "Prime Therapeutics",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Regence BlueShield",
          "slug": "REGENCEBS",
          "id": "WA-MA-REGENCEBS",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "Cambia Health",
          "pbm": "Prime Therapeutics",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "UnitedHealthcare",
          "slug": "UHC",
          "id": "WA-MA-UHC",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "UnitedHealth Group",
          "pbm": "OptumRx",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Washington Apple Health (Medicaid)",
          "slug": "wa-apple-health",
          "id": "WA-MCD-APPLE",
          "lob": "Medicaid Unified",
          "lobCode": "MCD",
          "parent": "WA Health Care Authority",
          "pbm": "State-managed",
          "url": "https://www.hca.wa.gov/",
          "turnaround": "⚠️ 3 calendar days (E2SHB 1357)",
          "expedited": "1 calendar day (expedited)",
          "goldCard": "NO Gold Card - SB 5395 FAILED",
          "channel": "GAMMIS / MCO Portals"
        },
        {
          "name": "Noridian Healthcare Solutions",
          "slug": "noridian-jf-wa",
          "id": "WA-PARTB-NORIDIAN",
          "lob": "PARTB",
          "lobCode": "PARTB",
          "parent": "Noridian Healthcare Solutions",
          "pbm": "N/A - Medicare",
          "url": "https://med.noridianmedicare.com/",
          "turnaround": "N/A - LCD determines",
          "expedited": null,
          "goldCard": "N/A - Federal Medicare",
          "channel": "Noridian Portal / esMD"
        },
        {
          "name": "Washington Apple Health for Kids - Molina",
          "slug": "molina-wa-chip",
          "id": "WA-CHIP-MOLINA",
          "lob": "CHIP",
          "lobCode": "CHIP",
          "parent": "Molina Healthcare",
          "pbm": "CVS Caremark",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Washington Apple Health for Kids - UnitedHealthcare CP",
          "slug": "uhc-wa-chip",
          "id": "WA-CHIP-UHC",
          "lob": "CHIP",
          "lobCode": "CHIP",
          "parent": "UnitedHealth Group",
          "pbm": "OptumRx",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Washington Apple Health for Kids - Coordinated Care",
          "slug": "coordcare-wa-chip",
          "id": "WA-CHIP-COORDCARE",
          "lob": "CHIP",
          "lobCode": "CHIP",
          "parent": "Centene",
          "pbm": "Centene PBM",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Noridian Healthcare Solutions (WA)",
          "slug": "NORIDIAN",
          "id": "WA-MAC-NORIDIAN",
          "lob": "Medicare MAC",
          "lobCode": "MAC",
          "parent": "Noridian",
          "pbm": "N/A - Medical Benefit",
          "url": "https://med.noridianmedicare.com/",
          "turnaround": "N/A - Post-service",
          "expedited": "N/A - Post-service",
          "goldCard": "N/A - Federal Medicare",
          "channel": "Claims-based / LCD compliance"
        },
        {
          "name": "PREMERA",
          "slug": null,
          "id": "WA-COM-PREMERA",
          "lob": "COM",
          "lobCode": null,
          "parent": null,
          "pbm": null,
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
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        {
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        {
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        {
          "name": "Montana Medicaid FFS",
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          "pbm": "State SPBM",
          "url": "https://dphhs.mt.gov/montanahealthcareprograms",
          "turnaround": "7 days",
          "expedited": "72 hours",
          "goldCard": "N/A - Medicaid",
          "channel": "State Medicaid Portal"
        },
        {
          "name": "Montana Medicaid",
          "slug": "MTMED",
          "id": "MT-MCD-MTMED",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": null,
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        }
      ],
      "NM": [
        {
          "name": "Ambetter",
          "slug": "AMBET",
          "id": "NM-COM-AMBET",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "Centene",
          "pbm": "Express Scripts",
          "url": null,
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          "channel": null
        },
        {
          "name": "Health Care Service Corp. (BCBSNM)",
          "slug": "BCBSNM",
          "id": "NM-COM-BCBSNM",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "HCSC",
          "pbm": "Prime Therapeutics",
          "url": "https://www.bcbsnm.com/",
          "turnaround": "Standard",
          "expedited": "Expedited",
          "goldCard": "⚠️ NMAC 13.10.31.12",
          "channel": "Prime/Availity/EviCore"
        },
        {
          "name": "Molina Healthcare",
          "slug": "MOLINA",
          "id": "NM-COM-MOLINA",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "Molina Healthcare",
          "pbm": "CVS Caremark",
          "url": null,
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        },
        {
          "name": "Presbyterian Health Plan",
          "slug": "PRESBYNM",
          "id": "NM-COM-PRESBYNM",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "Presbyterian Healthcare",
          "pbm": "Express Scripts",
          "url": "https://www.phs.org/",
          "turnaround": "Standard",
          "expedited": "Expedited",
          "goldCard": "⚠️ NMAC 13.10.31.12 (90% threshold - carrier selects 30%)",
          "channel": "Presbyterian Portal"
        },
        {
          "name": "UnitedHealthcare",
          "slug": "UHC",
          "id": "NM-COM-UHC",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "UnitedHealth Group",
          "pbm": "OptumRx",
          "url": "https://www.uhcprovider.com/",
          "turnaround": "Standard",
          "expedited": "Expedited",
          "goldCard": "✓ NMAC 13.10.31.12 acknowledged",
          "channel": "Optum Pro Portal"
        },
        {
          "name": "Blue Cross Blue Shield of New Mexico",
          "slug": "NMBCBS",
          "id": "NM-MCD-NMBCBS",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "HCSC",
          "pbm": "Prime Therapeutics",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Presbyterian Health Plan",
          "slug": "PRESBYHEALTH",
          "id": "NM-MCD-PRESBYHEALTH",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "Presbyterian Healthcare Services",
          "pbm": "Express Scripts",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Western Sky Community Care",
          "slug": "WESTERNSKY",
          "id": "NM-MCD-WESTERNSKY",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "Centene",
          "pbm": "Envolve Pharmacy Solutions",
          "url": null,
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          "goldCard": null,
          "channel": null
        },
        {
          "name": "Blue Cross Blue Shield of NM",
          "slug": "NMBCBS",
          "id": "NM-MA-NMBCBS",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "HCSC",
          "pbm": "Prime Therapeutics",
          "url": null,
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          "goldCard": null,
          "channel": null
        },
        {
          "name": "Humana",
          "slug": "HUMANA",
          "id": "NM-MA-HUMANA",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "Humana Inc.",
          "pbm": "Humana Pharmacy Solutions",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Molina Healthcare",
          "slug": "MOLINA",
          "id": "NM-MA-MOLINA",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "Molina Healthcare",
          "pbm": "CVS Caremark",
          "url": null,
          "turnaround": null,
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          "goldCard": null,
          "channel": null
        },
        {
          "name": "Presbyterian Health Plan",
          "slug": "PRESBYNM",
          "id": "NM-MA-PRESBYNM",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "Presbyterian Healthcare Services",
          "pbm": "Express Scripts",
          "url": null,
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          "goldCard": null,
          "channel": null
        },
        {
          "name": "UnitedHealthcare",
          "slug": "UHC",
          "id": "NM-MA-UHC",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "UnitedHealth Group",
          "pbm": "OptumRx",
          "url": null,
          "turnaround": null,
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          "goldCard": null,
          "channel": null
        },
        {
          "name": "Molina Healthcare New Mexico",
          "slug": "molina-nm",
          "id": "NM-MCD-MOLINA",
          "lob": "Medicaid/Exchange",
          "lobCode": "MCD",
          "parent": "Molina Healthcare",
          "pbm": "Molina PBM",
          "url": "https://www.molinahealthcare.com/",
          "turnaround": "Standard",
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          "goldCard": null,
          "channel": "Molina Portal"
        },
        {
          "name": "Novitas Solutions (NM)",
          "slug": "novitas-jh-nm",
          "id": "NM-PARTB-NOVITAS",
          "lob": "PARTB",
          "lobCode": "PARTB",
          "parent": "Novitas Solutions",
          "pbm": null,
          "url": "https://www.novitas-solutions.com/",
          "turnaround": "LCD",
          "expedited": null,
          "goldCard": "N/A - Federal",
          "channel": "Novitas Portal"
        },
        {
          "name": "New Mexico Centennial Care Kids - Blue Cross Blue Shield NM",
          "slug": "bcbsnm-chip",
          "id": "NM-CHIP-BCBSNM",
          "lob": "CHIP",
          "lobCode": "CHIP",
          "parent": "HCSC",
          "pbm": "Prime Therapeutics",
          "url": null,
          "turnaround": null,
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          "goldCard": null,
          "channel": null
        },
        {
          "name": "New Mexico Centennial Care Kids - Presbyterian",
          "slug": "presbyterian-nm-chip",
          "id": "NM-CHIP-PRESBYTERIAN",
          "lob": "CHIP",
          "lobCode": "CHIP",
          "parent": "Presbyterian Healthcare",
          "pbm": "Presbyterian PBM",
          "url": null,
          "turnaround": null,
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          "goldCard": null,
          "channel": null
        },
        {
          "name": "New Mexico Centennial Care Kids - Western Sky",
          "slug": "westernsky-nm-chip",
          "id": "NM-CHIP-WESTERNSKY",
          "lob": "CHIP",
          "lobCode": "CHIP",
          "parent": "Centene",
          "pbm": "Centene PBM",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Novitas Solutions (NM)",
          "slug": "NOVITAS",
          "id": "NM-MAC-NOVITAS",
          "lob": "Medicare MAC",
          "lobCode": "MAC",
          "parent": "Novitas",
          "pbm": "N/A - Medical Benefit",
          "url": "https://www.novitas-solutions.com/",
          "turnaround": "N/A - Post-service",
          "expedited": "N/A - Post-service",
          "goldCard": "N/A - Federal Medicare",
          "channel": "Claims-based / LCD compliance"
        },
        {
          "name": "Presbyterian Health Plan",
          "slug": "PRESBY",
          "id": "NM-COM-PRESBY",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "Presbyterian Healthcare",
          "pbm": null,
          "url": "https://www.phs.org/",
          "turnaround": "7 days",
          "expedited": "72 hours",
          "goldCard": null,
          "channel": null
        },
        {
          "name": "BCBS New Mexico",
          "slug": "BCBSNM-CLUSTER",
          "id": "NM-COM-BCBSNM-CLUSTER",
          "lob": "COM",
          "lobCode": "COM",
          "parent": null,
          "pbm": null,
          "url": null,
          "turnaround": null,
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          "goldCard": null,
          "channel": null
        },
        {
          "name": "UnitedHealthcare Community Plan of New Mexico",
          "slug": "UHC",
          "id": "NM-MCD-UHC",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "UnitedHealth Group",
          "pbm": null,
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        }
      ],
      "AR": [
        {
          "name": "Ambetter (Celtic)",
          "slug": "AMBET",
          "id": "AR-COM-AMBET",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "Centene",
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          "url": null,
          "turnaround": null,
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          "channel": null
        },
        {
          "name": "Blue Cross Blue Shield of Arkansas",
          "slug": "BCBSAR",
          "id": "AR-COM-BCBSAR",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "Arkansas BCBS",
          "pbm": "Prime Therapeutics",
          "url": null,
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          "channel": null
        },
        {
          "name": "Cigna",
          "slug": "CIGNA",
          "id": "AR-COM-CIGNA",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "Cigna",
          "pbm": "Express Scripts",
          "url": null,
          "turnaround": null,
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          "goldCard": null,
          "channel": null
        },
        {
          "name": "QualChoice",
          "slug": "QUAL",
          "id": "AR-COM-QUAL",
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          "lobCode": "COM",
          "parent": "QualChoice",
          "pbm": "MedImpact",
          "url": null,
          "turnaround": null,
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          "channel": null
        },
        {
          "name": "UnitedHealthcare",
          "slug": "UHC",
          "id": "AR-COM-UHC",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "UnitedHealth Group",
          "pbm": "OptumRx",
          "url": null,
          "turnaround": null,
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          "goldCard": null,
          "channel": null
        },
        {
          "name": "Ambetter from Arkansas Health & Wellness",
          "slug": "AMBET",
          "id": "AR-MCD-AMBET",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "Centene",
          "pbm": "Envolve Pharmacy Solutions",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Arkansas Total Care",
          "slug": "ARTOTAL",
          "id": "AR-MCD-ARTOTAL",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "Centene",
          "pbm": "Envolve Pharmacy Solutions",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Empower Healthcare Solutions",
          "slug": "EMPOWER",
          "id": "AR-MCD-EMPOWER",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "Empower Healthcare Solutions",
          "pbm": "Express Scripts",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "QualChoice Health Plan",
          "slug": "QUALCHOICE",
          "id": "AR-MCD-QUALCHOICE",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "QualChoice",
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          "url": null,
          "turnaround": null,
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          "channel": null
        },
        {
          "name": "Aetna Medicare",
          "slug": "AETNACARE",
          "id": "AR-MA-AETNACARE",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "CVS Health",
          "pbm": "CVS Caremark",
          "url": null,
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        },
        {
          "name": "Humana",
          "slug": "HUMANA",
          "id": "AR-MA-HUMANA",
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          "lobCode": "MA",
          "parent": "Humana Inc.",
          "pbm": "Humana Pharmacy Solutions",
          "url": null,
          "turnaround": null,
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        },
        {
          "name": "QualChoice",
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          "lobCode": "MA",
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          "channel": null
        },
        {
          "name": "UnitedHealthcare",
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          "id": "AR-MA-UHC",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "UnitedHealth Group",
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          "url": null,
          "turnaround": null,
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          "channel": null
        },
        {
          "name": "Arkansas BCBS (ABCBS)",
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          "lob": "Commercial",
          "lobCode": "COM",
          "parent": "Arkansas BCBS",
          "pbm": "CVS Caremark",
          "url": "https://www.arkansasbluecross.com/",
          "turnaround": "72 hours (Act 97)",
          "expedited": "24 hours",
          "goldCard": "✓ Act 575 Gold Card (90%) - but pharmacy PAs often persist",
          "channel": "ABCBS Portal"
        },
        {
          "name": "Arkansas Medicaid (FFS/PASSE)",
          "slug": "ar-medicaid",
          "id": "AR-MCD-DHS",
          "lob": "Medicaid FFS/MCO",
          "lobCode": "MCD",
          "parent": "AR DHS",
          "pbm": "Magellan/Prime",
          "url": "https://humanservices.arkansas.gov/",
          "turnaround": "72 hours",
          "expedited": "24 hours",
          "goldCard": "⚠️ Exempt from Act 575",
          "channel": "AR Medicaid Portal"
        },
        {
          "name": "Ambetter Arkansas",
          "slug": "ambetter-ar",
          "id": "AR-COM-AMBETTER",
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          "pbm": "Evolent/TurningPoint",
          "url": "https://www.ambetterhealth.com/",
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          "goldCard": "✓ Act 575 applies to J-codes",
          "channel": "Ambetter Portal"
        },
        {
          "name": "QualChoice Arkansas",
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          "id": "AR-COM-QUALCHOICE",
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          "lobCode": "COM",
          "parent": "QualChoice",
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          "url": "https://www.qualchoice.com/",
          "turnaround": "72 hours",
          "expedited": "24 hours",
          "goldCard": "✓ Act 575 - must attest to exemption status",
          "channel": "QualChoice Portal"
        },
        {
          "name": "Novitas Solutions (AR)",
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          "lobCode": "PARTB",
          "parent": "Novitas Solutions",
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          "url": "https://www.novitas-solutions.com/",
          "turnaround": "LCD",
          "expedited": null,
          "goldCard": "N/A - Federal",
          "channel": "Novitas Portal"
        },
        {
          "name": "Arkansas ARKids First - All plans",
          "slug": "arkidsfirst-ar-chip",
          "id": "AR-CHIP-ARKIDSFIRST",
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          "lobCode": "CHIP",
          "parent": "State of Arkansas",
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          "url": null,
          "turnaround": null,
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          "channel": null
        },
        {
          "name": "Novitas Solutions (AR)",
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          "lob": "Medicare MAC",
          "lobCode": "MAC",
          "parent": "Novitas",
          "pbm": "N/A - Medical Benefit",
          "url": "https://www.novitas-solutions.com/",
          "turnaround": "N/A - Post-service",
          "expedited": "N/A - Post-service",
          "goldCard": "N/A - Federal Medicare",
          "channel": "Claims-based / LCD compliance"
        },
        {
          "name": "Arkansas Medicaid FFS",
          "slug": "ARDHS",
          "id": "AR-MCD-ARDHS",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "AR DHS",
          "pbm": "State SPBM",
          "url": "https://humanservices.arkansas.gov/divisions-shared-services/medical-services/",
          "turnaround": "7 days",
          "expedited": "72 hours",
          "goldCard": "N/A - Medicaid",
          "channel": "State Medicaid Portal"
        },
        {
          "name": "Arkansas Medicaid",
          "slug": "ARMEDIC",
          "id": "AR-MCD-ARMEDIC",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": null,
          "pbm": null,
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "CareSource PASSE",
          "slug": "CARESOURCE",
          "id": "AR-MCD-CARESOURCE",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "CareSource",
          "pbm": null,
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        }
      ],
      "WI": [
        {
          "name": "Anthem (Elevance)",
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          "id": "WI-COM-ELEV",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "Elevance Health",
          "pbm": "IngenioRx (Carelon)",
          "url": null,
          "turnaround": null,
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          "goldCard": null,
          "channel": null
        },
        {
          "name": "Dean Health Plan",
          "slug": "DEAN",
          "id": "WI-COM-DEAN",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "Quartz",
          "pbm": "CVS Caremark",
          "url": "https://www.deancare.com/",
          "turnaround": "Standard",
          "expedited": "Expedited",
          "goldCard": null,
          "channel": "Dean Portal"
        },
        {
          "name": "Group Health Cooperative",
          "slug": "GROUPCOOP",
          "id": "WI-COM-GROUPCOOP",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "Group Health Cooperative",
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          "url": null,
          "turnaround": null,
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          "channel": null
        },
        {
          "name": "Quartz",
          "slug": "QUARTZ",
          "id": "WI-COM-QUARTZ",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "Quartz (Gundersen/UW Health)",
          "pbm": "CVS Caremark",
          "url": null,
          "turnaround": null,
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          "channel": null
        },
        {
          "name": "UnitedHealthcare",
          "slug": "UHC",
          "id": "WI-COM-UHC",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "UnitedHealth Group",
          "pbm": "OptumRx",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Anthem Blue Cross Blue Shield Wisconsin",
          "slug": "ANTHEM",
          "id": "WI-MCD-ANTHEM",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "Elevance Health",
          "pbm": "IngenioRx (Carelon)",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Care Wisconsin Health Plan",
          "slug": "WISCARE",
          "id": "WI-MCD-WISCARE",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "Care Wisconsin",
          "pbm": "Express Scripts",
          "url": null,
          "turnaround": null,
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          "channel": null
        },
        {
          "name": "Children's Community Health Plan",
          "slug": "CHILDCOMM",
          "id": "WI-MCD-CHILDCOMM",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "Children's Wisconsin",
          "pbm": "Express Scripts",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Compcare Health Services",
          "slug": "COMPCARE",
          "id": "WI-MCD-COMPCARE",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "Anthem/Elevance",
          "pbm": "IngenioRx (Carelon)",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Dean Health Plan",
          "slug": "DEANHEALTH",
          "id": "WI-MCD-DEANHEALTH",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "Quartz",
          "pbm": "CVS Caremark",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "GHC-SCW",
          "slug": "GHCSCW",
          "id": "WI-MCD-GHCSCW",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "Group Health Cooperative SCW",
          "pbm": "Express Scripts",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Molina Healthcare of Wisconsin",
          "slug": "MOLINA",
          "id": "WI-MCD-MOLINA",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "Molina Healthcare",
          "pbm": "CVS Caremark",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Quartz",
          "slug": "QUARTZ",
          "id": "WI-MCD-QUARTZ",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "Quartz (UnityPoint/Gundersen JV)",
          "pbm": "CVS Caremark",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "UnitedHealthcare Community Plan WI",
          "slug": "UHC",
          "id": "WI-MCD-UHC",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "UnitedHealth Group",
          "pbm": "OptumRx",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Aetna Medicare",
          "slug": "AETNACARE",
          "id": "WI-MA-AETNACARE",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "CVS Health",
          "pbm": "CVS Caremark",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Anthem (Elevance)",
          "slug": "ELEV",
          "id": "WI-MA-ELEV",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "Elevance Health",
          "pbm": "IngenioRx (Carelon)",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Dean Health Plan",
          "slug": "DEAN",
          "id": "WI-MA-DEAN",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "Quartz",
          "pbm": "CVS Caremark",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Humana",
          "slug": "HUMANA",
          "id": "WI-MA-HUMANA",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "Humana Inc.",
          "pbm": "Humana Pharmacy Solutions",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "UnitedHealthcare",
          "slug": "UHC",
          "id": "WI-MA-UHC",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "UnitedHealth Group",
          "pbm": "OptumRx",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Wisconsin ForwardHealth",
          "slug": "forwardhealth-wi",
          "id": "WI-MCD-FWH",
          "lob": "Medicaid FFS",
          "lobCode": "MCD",
          "parent": "WI DHS",
          "pbm": "ForwardHealth PBM",
          "url": "https://www.forwardhealth.wi.gov/",
          "turnaround": "Standard",
          "expedited": "Expedited",
          "goldCard": "N/A - Medicaid",
          "channel": "ForwardHealth Portal"
        },
        {
          "name": "Anthem BCBS Wisconsin",
          "slug": "anthem-wi",
          "id": "WI-COM-ANTHEM",
          "lob": "Commercial",
          "lobCode": "COM",
          "parent": "Elevance Health",
          "pbm": "Carelon",
          "url": "https://www.anthem.com/",
          "turnaround": "Standard",
          "expedited": "Expedited",
          "goldCard": "⚠️ SB 434 pending - not yet operational",
          "channel": "Availity"
        },
        {
          "name": "Common Ground Healthcare Cooperative",
          "slug": "cghc-wi",
          "id": "WI-COM-CGHC",
          "lob": "Exchange",
          "lobCode": "COM",
          "parent": "CGHC",
          "pbm": "OptumRx",
          "url": "https://www.commongroundhealthcare.org/",
          "turnaround": "Standard",
          "expedited": "Expedited",
          "goldCard": null,
          "channel": "CGHC Portal"
        },
        {
          "name": "National Government Services (WI)",
          "slug": "ngs-j6-wi",
          "id": "WI-PARTB-NGS",
          "lob": "PARTB",
          "lobCode": "PARTB",
          "parent": "NGS",
          "pbm": null,
          "url": "https://www.ngsmedicare.com/",
          "turnaround": "LCD",
          "expedited": null,
          "goldCard": "N/A - Federal",
          "channel": "NGS Portal"
        },
        {
          "name": "Wisconsin BadgerCare Plus",
          "slug": "badgercare-wi-chip",
          "id": "WI-CHIP-BADGERCARE",
          "lob": "CHIP",
          "lobCode": "CHIP",
          "parent": "State of Wisconsin",
          "pbm": "WI ForwardHealth",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Wisconsin BadgerCare Plus - Anthem",
          "slug": "anthem-wi-chip",
          "id": "WI-CHIP-ANTHEM",
          "lob": "CHIP",
          "lobCode": "CHIP",
          "parent": "Elevance Health",
          "pbm": "Elevance PBM",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Wisconsin BadgerCare Plus - Common Ground",
          "slug": "cghc-wi-chip",
          "id": "WI-CHIP-CGHC",
          "lob": "CHIP",
          "lobCode": "CHIP",
          "parent": "Common Ground Healthcare",
          "pbm": "CGHC PBM",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "National Government Services (WI)",
          "slug": "NGS",
          "id": "WI-MAC-NGS",
          "lob": "Medicare MAC",
          "lobCode": "MAC",
          "parent": "NGS",
          "pbm": "N/A - Medical Benefit",
          "url": "https://www.ngsmedicare.com/",
          "turnaround": "N/A - Post-service",
          "expedited": "N/A - Post-service",
          "goldCard": "N/A - Federal Medicare",
          "channel": "Claims-based / LCD compliance"
        },
        {
          "name": "FORWARD",
          "slug": null,
          "id": "WI-MCD-FORWARD",
          "lob": "MCD",
          "lobCode": null,
          "parent": null,
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          "url": null,
          "turnaround": null,
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          "goldCard": null,
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        },
        {
          "name": "ForwardHealth (WI Medicaid)",
          "slug": "FORWARD-CLUSTER",
          "id": "WI-MCD-FORWARD-CLUSTER",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": null,
          "pbm": null,
          "url": null,
          "turnaround": null,
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          "goldCard": null,
          "channel": null
        },
        {
          "name": "CareSource Wisconsin",
          "slug": "CARESOURCE",
          "id": "WI-COM-CARESOURCE",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "CareSource",
          "pbm": null,
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        }
      ],
      "SD": [
        {
          "name": "Avera Health Plans",
          "slug": "AVERA",
          "id": "SD-COM-AVERA",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "Avera Health",
          "pbm": "Express Scripts",
          "url": null,
          "turnaround": null,
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          "goldCard": null,
          "channel": null
        },
        {
          "name": "Medica",
          "slug": "MEDICA",
          "id": "SD-COM-MEDICA",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "Medica",
          "pbm": "Express Scripts",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Sanford Health Plan",
          "slug": "SANFORD",
          "id": "SD-COM-SANFORD",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "Sanford Health",
          "pbm": "Express Scripts",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Wellmark",
          "slug": "WELLMARK",
          "id": "SD-COM-WELLMARK",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "Wellmark",
          "pbm": "CVS Caremark",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Avera Health Plans",
          "slug": "AVERA",
          "id": "SD-MA-AVERA",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "Avera Health",
          "pbm": "Express Scripts",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Medica",
          "slug": "MEDICA",
          "id": "SD-MA-MEDICA",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "Medica",
          "pbm": "Express Scripts",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Sanford Health Plan",
          "slug": "SANFORD",
          "id": "SD-MA-SANFORD",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "Sanford Health",
          "pbm": "Express Scripts",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "UnitedHealthcare",
          "slug": "UHC",
          "id": "SD-MA-UHC",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "UnitedHealth Group",
          "pbm": "OptumRx",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "South Dakota Medicaid",
          "slug": "sd-medicaid",
          "id": "SD-MCD-DSS",
          "lob": "Medicaid FFS",
          "lobCode": "MCD",
          "parent": "SD DSS",
          "pbm": "OptumRx",
          "url": "https://dss.sd.gov/",
          "turnaround": "Standard",
          "expedited": "Expedited",
          "goldCard": "N/A - Medicaid",
          "channel": "SD Medicaid Portal"
        },
        {
          "name": "Noridian Healthcare Solutions (SD)",
          "slug": "noridian-jf-sd",
          "id": "SD-PARTB-NORIDIAN",
          "lob": "PARTB",
          "lobCode": "PARTB",
          "parent": "Noridian",
          "pbm": null,
          "url": "https://med.noridianmedicare.com/",
          "turnaround": "LCD",
          "expedited": null,
          "goldCard": "N/A - Federal",
          "channel": "Noridian Portal"
        },
        {
          "name": "South Dakota CHIP - All plans",
          "slug": "sd-chip",
          "id": "SD-CHIP-SD",
          "lob": "CHIP",
          "lobCode": "CHIP",
          "parent": "State of South Dakota",
          "pbm": "SD DSS",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Noridian Healthcare Solutions (SD)",
          "slug": "NORIDIAN",
          "id": "SD-MAC-NORIDIAN",
          "lob": "Medicare MAC",
          "lobCode": "MAC",
          "parent": "Noridian",
          "pbm": "N/A - Medical Benefit",
          "url": "https://med.noridianmedicare.com/",
          "turnaround": "N/A - Post-service",
          "expedited": "N/A - Post-service",
          "goldCard": "N/A - Federal Medicare",
          "channel": "Claims-based / LCD compliance"
        },
        {
          "name": "South Dakota Medicaid FFS",
          "slug": "SDDSS",
          "id": "SD-MCD-SDDSS",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "SD DSS",
          "pbm": "State SPBM",
          "url": "https://dss.sd.gov/medicaid/",
          "turnaround": "7 days",
          "expedited": "72 hours",
          "goldCard": "N/A - Medicaid",
          "channel": "State Medicaid Portal"
        },
        {
          "name": "Medicare Part D",
          "slug": "VARIOUS",
          "id": "SD-PARTD-VARIOUS",
          "lob": "PARTD",
          "lobCode": "PARTD",
          "parent": null,
          "pbm": null,
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          "turnaround": null,
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          "channel": null
        },
        {
          "name": "DakotaCare",
          "slug": "DAKOTACARE",
          "id": "SD-COM-DAKOTACARE",
          "lob": "COM",
          "lobCode": "COM",
          "parent": null,
          "pbm": null,
          "url": null,
          "turnaround": null,
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        }
      ],
      "AL": [
        {
          "name": "Blue Cross Blue Shield of Alabama",
          "slug": "BCBSAL",
          "id": "AL-COM-BCBSAL",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "BCBSAL",
          "pbm": "Prime Therapeutics",
          "url": "https://www.bcbsal.org/",
          "turnaround": "Standard",
          "expedited": "Expedited",
          "goldCard": "✓ Voluntary 'Consensus Agreement' Gold Card + No AI Denial",
          "channel": "BCBSAL Portal"
        },
        {
          "name": "UnitedHealthcare",
          "slug": "UHC",
          "id": "AL-COM-UHC",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "UnitedHealth Group",
          "pbm": "OptumRx",
          "url": "https://www.uhcprovider.com/",
          "turnaround": "Standard",
          "expedited": "Expedited",
          "goldCard": "✓ National Gold Card 92%",
          "channel": "UHC Portal"
        },
        {
          "name": "Aetna Medicare",
          "slug": "AETNACARE",
          "id": "AL-MA-AETNACARE",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "CVS Health",
          "pbm": "CVS Caremark",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Blue Cross Blue Shield of Alabama",
          "slug": "ALBCBS",
          "id": "AL-MA-ALBCBS",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "BCBSAL",
          "pbm": "Prime Therapeutics",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Humana",
          "slug": "HUMANA",
          "id": "AL-MA-HUMANA",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "Humana Inc.",
          "pbm": "Humana Pharmacy Solutions",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "UnitedHealthcare",
          "slug": "UHC",
          "id": "AL-MA-UHC",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "UnitedHealth Group",
          "pbm": "OptumRx",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Alabama Medicaid Agency",
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          "id": "AL-MCD-AMA",
          "lob": "Medicaid FFS",
          "lobCode": "MCD",
          "parent": "Alabama Medicaid",
          "pbm": "Acentra Health",
          "url": "https://medicaid.alabama.gov/",
          "turnaround": "Standard",
          "expedited": "Expedited",
          "goldCard": "N/A - Medicaid",
          "channel": "Acentra Portal"
        },
        {
          "name": "Viva Health Alabama",
          "slug": "viva-al",
          "id": "AL-COM-VIVA",
          "lob": "Commercial/MA",
          "lobCode": "COM",
          "parent": "UAB Health",
          "pbm": "Express Scripts",
          "url": "https://www.vivahealth.com/",
          "turnaround": "Standard",
          "expedited": "Expedited",
          "goldCard": null,
          "channel": "Viva Portal"
        },
        {
          "name": "Palmetto GBA (AL)",
          "slug": "palmetto-jj-al",
          "id": "AL-PARTB-PALMETTO",
          "lob": "PARTB",
          "lobCode": "PARTB",
          "parent": "Palmetto GBA",
          "pbm": null,
          "url": "https://www.palmettogba.com/",
          "turnaround": "LCD",
          "expedited": null,
          "goldCard": "N/A - Federal",
          "channel": "Palmetto Portal"
        },
        {
          "name": "Alabama ALL Kids - Blue Cross AL",
          "slug": "bcbsal-chip",
          "id": "AL-CHIP-BCBSAL",
          "lob": "CHIP",
          "lobCode": "CHIP",
          "parent": "BCBSAL",
          "pbm": "BCBSAL PBM",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Palmetto GBA (AL)",
          "slug": "PALMETTO",
          "id": "AL-MAC-PALMETTO",
          "lob": "Medicare MAC",
          "lobCode": "MAC",
          "parent": "Palmetto GBA",
          "pbm": "N/A - Medical Benefit",
          "url": "https://www.palmettogba.com/",
          "turnaround": "N/A - Post-service",
          "expedited": "N/A - Post-service",
          "goldCard": "N/A - Federal Medicare",
          "channel": "Claims-based / LCD compliance"
        },
        {
          "name": "Alabama Medicaid",
          "slug": "ALMED",
          "id": "AL-MCD-ALMED",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": null,
          "pbm": null,
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Oscar Insurance",
          "slug": "OSCAR",
          "id": "AL-ACA-OSCAR",
          "lob": "ACA",
          "lobCode": "ACA",
          "parent": "Oscar Health",
          "pbm": null,
          "url": null,
          "turnaround": null,
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          "goldCard": null,
          "channel": null
        },
        {
          "name": "Simpra Advantage Inc.",
          "slug": "SIMPRA",
          "id": "AL-MA-SIMPRA",
          "lob": "MA",
          "lobCode": "MA",
          "parent": null,
          "pbm": null,
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        }
      ],
      "MN": [
        {
          "name": "Blue Cross Blue Shield of Minnesota",
          "slug": "MINNBCBS",
          "id": "MN-COM-MINNBCBS",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "BCBSMN",
          "pbm": "Prime Therapeutics",
          "url": "https://securecms.bluecrossmnonline.com/content/medpolicy/en/minnesota/core/all/policies/Medicine/II-16/II-16-010.html",
          "turnaround": "7 days",
          "expedited": "72 hours",
          "goldCard": "None - MN has Platinum Card (§62M.07) instead",
          "channel": "Portal"
        },
        {
          "name": "HealthPartners",
          "slug": "PARTNERS",
          "id": "MN-COM-PARTNERS",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "HealthPartners",
          "pbm": "Express Scripts",
          "url": "https://www.healthpartners.com/ucm/groups/public/@hp/@public/@cc/documents/documents/aentry_045822.pdf",
          "turnaround": "7 days",
          "expedited": "72 hours",
          "goldCard": "MN §62M.07 Platinum Card applies",
          "channel": "Portal"
        },
        {
          "name": "Medica",
          "slug": "MEDICA",
          "id": "MN-COM-MEDICA",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "Medica",
          "pbm": "Express Scripts",
          "url": "https://partner.medica.com/providers/ucare-member-transition",
          "turnaround": "7 days",
          "expedited": "72 hours",
          "goldCard": "MN §62M.07 Platinum Card applies",
          "channel": "Portal"
        },
        {
          "name": "PreferredOne",
          "slug": "PREFERONE",
          "id": "MN-COM-PREFERONE",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "Fairview Health",
          "pbm": "Express Scripts",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "UnitedHealthcare",
          "slug": "UHC",
          "id": "MN-COM-UHC",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "UnitedHealth Group",
          "pbm": "OptumRx",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Blue Plus",
          "slug": "BLUEPLUS",
          "id": "MN-MCD-BLUEPLUS",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "Blue Cross Blue Shield of Minnesota",
          "pbm": "Prime Therapeutics",
          "url": "https://mn.gov/dhs/assets/preferred-drug-list-2025-06-17_tcm1053-693404.pdf",
          "turnaround": "7 days",
          "expedited": "72 hours",
          "goldCard": "MN §62M.07 Platinum Card applies",
          "channel": "Portal"
        },
        {
          "name": "HealthPartners",
          "slug": "PARTNERS",
          "id": "MN-MCD-PARTNERS",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "HealthPartners",
          "pbm": "Express Scripts",
          "url": "https://www.healthpartnersplans.com/home/providers/tools-and-resources/formularies/",
          "turnaround": "7 days",
          "expedited": "72 hours",
          "goldCard": "MN §62M.07 Platinum Card applies",
          "channel": "Portal"
        },
        {
          "name": "Hennepin Health",
          "slug": "HENNEPIN",
          "id": "MN-MCD-HENNEPIN",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "Hennepin Healthcare",
          "pbm": "Express Scripts",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Medica",
          "slug": "MEDICA",
          "id": "MN-MCD-MEDICA",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "Medica",
          "pbm": "Express Scripts",
          "url": "https://partner.medica.com/providers/ucare-member-transition",
          "turnaround": "7 days",
          "expedited": "72 hours",
          "goldCard": "MN §62M.07 Platinum Card applies",
          "channel": "Portal"
        },
        {
          "name": "UCare",
          "slug": "UCARE",
          "id": "MN-MCD-UCARE",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "UCare",
          "pbm": "OptumRx",
          "url": "https://disabilityhubmn.org/news/frequently-asked-questions-for-medica-and-ucare-agreement/",
          "turnaround": "7 days",
          "expedited": "72 hours",
          "goldCard": "N/A - Transitioning to Medica",
          "channel": "Portal (Legacy)"
        },
        {
          "name": "UnitedHealthcare Community Plan Minnesota",
          "slug": "UHC",
          "id": "MN-MCD-UHC",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "UnitedHealth Group",
          "pbm": "OptumRx",
          "url": "https://content.govdelivery.com/accounts/MNDHS/bulletins/3c65f1d",
          "turnaround": "7 days",
          "expedited": "72 hours",
          "goldCard": "N/A - Exiting Medicaid",
          "channel": "Portal (SmartPA)"
        },
        {
          "name": "Blue Cross Blue Shield of Minnesota",
          "slug": "MNBCBS",
          "id": "MN-MA-MNBCBS",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "BCBSMN",
          "pbm": "Prime Therapeutics",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "HealthPartners",
          "slug": "HPARTNERS",
          "id": "MN-MA-HPARTNERS",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "HealthPartners",
          "pbm": "Express Scripts",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Medica",
          "slug": "MEDICA",
          "id": "MN-MA-MEDICA",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "Medica",
          "pbm": "Express Scripts",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "UCare",
          "slug": "UCAREMN",
          "id": "MN-MA-UCAREMN",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "UCare",
          "pbm": "OptumRx",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "UnitedHealthcare",
          "slug": "UHC",
          "id": "MN-MA-UHC",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "UnitedHealth Group",
          "pbm": "OptumRx",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "National Government Services (NGS)",
          "slug": "NGS",
          "id": "MN-PARTB-NGS",
          "lob": "PARTB",
          "lobCode": "PARTB",
          "parent": "National Government Services",
          "pbm": null,
          "url": "https://www.wpsgha.com/news-updates/view/858",
          "turnaround": "7 days",
          "expedited": "72 hours",
          "goldCard": "N/A - Federal Medicare",
          "channel": "Portal"
        },
        {
          "name": "Minnesota MinnesotaCare - All plans",
          "slug": "mncare-mn-chip",
          "id": "MN-CHIP-MNCARE",
          "lob": "CHIP",
          "lobCode": "CHIP",
          "parent": "State of Minnesota",
          "pbm": "MN DHS",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
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        },
        {
          "name": "Minnesota MinnesotaCare - HealthPartners",
          "slug": "healthpartners-mn-chip",
          "id": "MN-CHIP-HEALTHPARTNERS",
          "lob": "CHIP",
          "lobCode": "CHIP",
          "parent": "HealthPartners",
          "pbm": "HP PBM",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Minnesota MinnesotaCare - UCare",
          "slug": "ucare-mn-chip",
          "id": "MN-CHIP-UCARE",
          "lob": "CHIP",
          "lobCode": "CHIP",
          "parent": "UCare",
          "pbm": "UCare PBM",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Minnesota MinnesotaCare - Blue Plus",
          "slug": "blueplus-mn-chip",
          "id": "MN-CHIP-BLUEPLUS",
          "lob": "CHIP",
          "lobCode": "CHIP",
          "parent": "Blue Cross MN",
          "pbm": "Prime Therapeutics",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "National Government Services (MN)",
          "slug": "NGS",
          "id": "MN-MAC-NGS",
          "lob": "Medicare MAC",
          "lobCode": "MAC",
          "parent": "NGS",
          "pbm": "N/A - Medical Benefit",
          "url": "https://www.ngsmedicare.com/",
          "turnaround": "N/A - Post-service",
          "expedited": "N/A - Post-service",
          "goldCard": "N/A - Federal Medicare",
          "channel": "Claims-based / LCD compliance"
        },
        {
          "name": "BCBS Minnesota",
          "slug": "BCBSMN",
          "id": "MN-COM-BCBSMN",
          "lob": "COM",
          "lobCode": "COM",
          "parent": null,
          "pbm": null,
          "url": null,
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        },
        {
          "name": "HealthPartners",
          "slug": "HEALTHPART",
          "id": "MN-COM-HEALTHPART",
          "lob": "COM",
          "lobCode": "COM",
          "parent": null,
          "pbm": null,
          "url": null,
          "turnaround": null,
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          "goldCard": null,
          "channel": null
        },
        {
          "name": "Simplica (HealthPartners)",
          "slug": "SIMPLICA",
          "id": "MN-COM-SIMPLICA",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "HealthPartners",
          "pbm": null,
          "url": null,
          "turnaround": null,
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          "goldCard": null,
          "channel": null
        }
      ],
      "ND": [
        {
          "name": "Blue Cross Blue Shield of North Dakota",
          "slug": "NDAKBCBS",
          "id": "ND-COM-NDAKBCBS",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "BCBSND (Noridian)",
          "pbm": "Prime Therapeutics",
          "url": null,
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        },
        {
          "name": "Medica",
          "slug": "MEDICA",
          "id": "ND-COM-MEDICA",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "Medica",
          "pbm": "Express Scripts",
          "url": null,
          "turnaround": null,
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          "goldCard": null,
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        },
        {
          "name": "Sanford Health Plan",
          "slug": "SANFORD",
          "id": "ND-COM-SANFORD",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "Sanford Health",
          "pbm": "Express Scripts",
          "url": null,
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          "channel": null
        },
        {
          "name": "UnitedHealthcare",
          "slug": "UHC",
          "id": "ND-COM-UHC",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "UnitedHealth Group",
          "pbm": "OptumRx",
          "url": null,
          "turnaround": null,
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          "channel": null
        },
        {
          "name": "Blue Cross Blue Shield of ND",
          "slug": "NDBCBS",
          "id": "ND-MA-NDBCBS",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "Noridian",
          "pbm": "Prime Therapeutics",
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        },
        {
          "name": "Medica",
          "slug": "MEDICA",
          "id": "ND-MA-MEDICA",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "Medica",
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          "url": null,
          "turnaround": null,
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          "channel": null
        },
        {
          "name": "Sanford Health Plan",
          "slug": "SANFORD",
          "id": "ND-MA-SANFORD",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "Sanford Health",
          "pbm": "Express Scripts",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "UnitedHealthcare",
          "slug": "UHC",
          "id": "ND-MA-UHC",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "UnitedHealth Group",
          "pbm": "OptumRx",
          "url": null,
          "turnaround": null,
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          "channel": null
        },
        {
          "name": "Blue Cross Blue Shield North Dakota",
          "slug": "bcbsnd-nd",
          "id": "ND-COM-BCBSND",
          "lob": "Commercial",
          "lobCode": "COM",
          "parent": "BCBSND",
          "pbm": "BCBSND PBM",
          "url": "https://www.bcbsnd.com/",
          "turnaround": "Standard",
          "expedited": "Expedited",
          "goldCard": "✓ SB 2280 Gold Card (90%)",
          "channel": "BCBSND Portal"
        },
        {
          "name": "North Dakota Medicaid",
          "slug": "nd-medicaid",
          "id": "ND-MCD-DHS",
          "lob": "Medicaid FFS",
          "lobCode": "MCD",
          "parent": "ND DHS",
          "pbm": "Acentra Health",
          "url": "https://www.nd.gov/dhs/",
          "turnaround": "Standard",
          "expedited": "Expedited",
          "goldCard": "N/A - Medicaid",
          "channel": "ND Medicaid Portal"
        },
        {
          "name": "Noridian Healthcare Solutions (ND)",
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          "lob": "PARTB",
          "lobCode": "PARTB",
          "parent": "Noridian",
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          "url": "https://med.noridianmedicare.com/",
          "turnaround": "LCD",
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          "goldCard": "N/A - Federal",
          "channel": "Noridian Portal"
        },
        {
          "name": "North Dakota Healthy Steps - All plans",
          "slug": "healthysteps-nd-chip",
          "id": "ND-CHIP-HEALTHYSTEPS",
          "lob": "CHIP",
          "lobCode": "CHIP",
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          "pbm": "ND DHS",
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        },
        {
          "name": "Noridian Healthcare Solutions (ND)",
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          "lob": "Medicare MAC",
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          "url": "https://med.noridianmedicare.com/",
          "turnaround": "N/A - Post-service",
          "expedited": "N/A - Post-service",
          "goldCard": "N/A - Federal Medicare",
          "channel": "Claims-based / LCD compliance"
        },
        {
          "name": "North Dakota Medicaid FFS",
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          "turnaround": "7 days",
          "expedited": "72 hours",
          "goldCard": "N/A - Medicaid",
          "channel": "State Medicaid Portal"
        },
        {
          "name": "ND Medicaid",
          "slug": "NDMEDIC",
          "id": "ND-MCD-NDMEDIC",
          "lob": "MCD",
          "lobCode": "MCD",
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        },
        {
          "name": "NextBlue of North Dakota",
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          "lob": "MA",
          "lobCode": "MA",
          "parent": "Blue Cross Blue Shield of North Dakota",
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          "url": null,
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      ],
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          "name": "Blue Cross Blue Shield of Vermont",
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          "lob": "COM",
          "lobCode": "COM",
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          "pbm": "CVS Caremark",
          "url": null,
          "turnaround": null,
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          "channel": null
        },
        {
          "name": "Cigna",
          "slug": "CIGNA",
          "id": "VT-COM-CIGNA",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "Cigna",
          "pbm": "Express Scripts",
          "url": null,
          "turnaround": null,
          "expedited": null,
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          "channel": null
        },
        {
          "name": "MVP Health Care",
          "slug": "MVPHEALTH",
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          "lobCode": "COM",
          "parent": "MVP Health Care",
          "pbm": "Express Scripts",
          "url": null,
          "turnaround": null,
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          "channel": null
        },
        {
          "name": "UnitedHealthcare",
          "slug": "UHC",
          "id": "VT-COM-UHC",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "UnitedHealth Group",
          "pbm": "OptumRx",
          "url": null,
          "turnaround": null,
          "expedited": null,
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          "channel": null
        },
        {
          "name": "Aetna Medicare",
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          "id": "VT-MA-AETNACARE",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "CVS Health",
          "pbm": "CVS Caremark",
          "url": null,
          "turnaround": null,
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        },
        {
          "name": "Blue Cross Blue Shield of Vermont",
          "slug": "VTBCBS",
          "id": "VT-MA-VTBCBS",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "BCBSVT (now part of BCBSM)",
          "pbm": "CVS Caremark",
          "url": null,
          "turnaround": null,
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          "channel": null
        },
        {
          "name": "MVP Health Care",
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          "lob": "MA",
          "lobCode": "MA",
          "parent": "MVP Health Care",
          "pbm": "Express Scripts",
          "url": null,
          "turnaround": null,
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          "goldCard": null,
          "channel": null
        },
        {
          "name": "UnitedHealthcare",
          "slug": "UHC",
          "id": "VT-MA-UHC",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "UnitedHealth Group",
          "pbm": "OptumRx",
          "url": null,
          "turnaround": null,
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          "goldCard": null,
          "channel": null
        },
        {
          "name": "Blue Cross Blue Shield Vermont",
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          "id": "VT-COM-BCBSVT",
          "lob": "Commercial",
          "lobCode": "COM",
          "parent": "BCBSVT",
          "pbm": "BCBSVT PBM",
          "url": "https://www.bcbsvt.com/",
          "turnaround": "Standard",
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          "goldCard": "✓ Act 111 Gold Card (90%)",
          "channel": "BCBSVT Portal"
        },
        {
          "name": "MVP Health Care Vermont",
          "slug": "mvp-vt",
          "id": "VT-COM-MVP",
          "lob": "Commercial",
          "lobCode": "COM",
          "parent": "MVP Health Care",
          "pbm": "MVP PBM",
          "url": "https://www.mvphealthcare.com/",
          "turnaround": "Standard",
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          "goldCard": "✓ Act 111 Gold Card (90%)",
          "channel": "MVP Portal"
        },
        {
          "name": "Vermont Medicaid (DVHA)",
          "slug": "vt-medicaid",
          "id": "VT-MCD-DVHA",
          "lob": "Medicaid FFS",
          "lobCode": "MCD",
          "parent": "Vermont AHS",
          "pbm": "VT Medicaid PBM",
          "url": "https://dvha.vermont.gov/",
          "turnaround": "72 hours (Act 111)",
          "expedited": "24 hours",
          "goldCard": "N/A - Medicaid",
          "channel": "VT Medicaid Portal"
        },
        {
          "name": "Humana Vermont",
          "slug": "humana-vt",
          "id": "VT-MA-HUMANA",
          "lob": "Medicare MA",
          "lobCode": "MA",
          "parent": "Humana",
          "pbm": "Humana PBM",
          "url": "https://www.humana.com/",
          "turnaround": "Standard",
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          "goldCard": null,
          "channel": "Humana Portal"
        },
        {
          "name": "NGS (Vermont)",
          "slug": "ngs-jk-vt",
          "id": "VT-PARTB-NGS",
          "lob": "PARTB",
          "lobCode": "PARTB",
          "parent": "National Government Services",
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          "url": "https://www.ngsmedicare.com/",
          "turnaround": "LCD",
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          "goldCard": "N/A - Federal",
          "channel": "NGS Portal"
        },
        {
          "name": "Vermont Dr. Dynasaur - All plans",
          "slug": "drdynasaur-vt-chip",
          "id": "VT-CHIP-DRDYNASAUR",
          "lob": "CHIP",
          "lobCode": "CHIP",
          "parent": "State of Vermont",
          "pbm": "VT DVHA",
          "url": null,
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        },
        {
          "name": "National Government Services (VT)",
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          "id": "VT-MAC-NGS",
          "lob": "Medicare MAC",
          "lobCode": "MAC",
          "parent": "NGS",
          "pbm": "N/A - Medical Benefit",
          "url": "https://www.ngsmedicare.com/",
          "turnaround": "N/A - Post-service",
          "expedited": "N/A - Post-service",
          "goldCard": "N/A - Federal Medicare",
          "channel": "Claims-based / LCD compliance"
        },
        {
          "name": "Vermont Medicaid FFS (DVHA)",
          "slug": "VTDVHA",
          "id": "VT-MCD-VTDVHA",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "VT DVHA",
          "pbm": "State SPBM",
          "url": "https://dvha.vermont.gov/",
          "turnaround": "7 days",
          "expedited": "72 hours",
          "goldCard": "N/A - Medicaid",
          "channel": "State Medicaid Portal"
        },
        {
          "name": "Vermont Education Health Initiative (VEHI)",
          "slug": "VEHI",
          "id": "VT-COM-VEHI",
          "lob": "COM",
          "lobCode": "COM",
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        }
      ],
      "ID": [
        {
          "name": "Blue Cross of Idaho",
          "slug": "BCID",
          "id": "ID-COM-BCID",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "Blue Cross of Idaho",
          "pbm": "Prime Therapeutics",
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        },
        {
          "name": "PacificSource",
          "slug": "PACIFIC",
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          "lob": "COM",
          "lobCode": "COM",
          "parent": "PacificSource",
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        },
        {
          "name": "Regence BlueShield of Idaho",
          "slug": "REGENCEBS",
          "id": "ID-COM-REGENCEBS",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "Cambia Health Solutions",
          "pbm": "Prime Therapeutics",
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        },
        {
          "name": "SelectHealth",
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          "id": "ID-COM-SELECT",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "Intermountain Health",
          "pbm": "Express Scripts",
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        {
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        {
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        },
        {
          "name": "Blue Cross of Idaho",
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        },
        {
          "name": "Humana",
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        {
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        },
        {
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        {
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        },
        {
          "name": "Regence BlueShield Idaho",
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        {
          "name": "SelectHealth Idaho",
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        {
          "name": "Idaho Medicaid (HB 345 Transition)",
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          "lobCode": "MCD",
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        },
        {
          "name": "UnitedHealthcare CP Idaho",
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          "id": "ID-MCD-UHC",
          "lob": "Medicaid MCO",
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          "parent": "UnitedHealth Group",
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        {
          "name": "Noridian Healthcare Solutions (ID)",
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          "url": "https://med.noridianmedicare.com/",
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          "goldCard": "N/A - Federal",
          "channel": "Noridian Portal"
        },
        {
          "name": "Idaho CHIP - Molina",
          "slug": "molina-id-chip",
          "id": "ID-CHIP-MOLINA",
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          "lobCode": "CHIP",
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        {
          "name": "Idaho CHIP - Blue Cross of Idaho",
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        {
          "name": "Noridian Healthcare Solutions (ID)",
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          "url": "https://med.noridianmedicare.com/",
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          "expedited": "N/A - Post-service",
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        },
        {
          "name": "Idaho Medicaid FFS",
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          "pbm": "State SPBM",
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          "channel": "State Medicaid Portal"
        },
        {
          "name": "Blue Cross Idaho",
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        },
        {
          "name": "Idaho Medicaid",
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        },
        {
          "name": "Molina Healthcare of Idaho Marketplace",
          "slug": "MOLINA",
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        },
        {
          "name": "Saint Alphonsus Health Plan",
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        },
        {
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          "url": "https://med.noridianmedicare.com/",
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          "goldCard": "N/A - Federal",
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        {
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        {
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        {
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        },
        {
          "name": "Noridian Healthcare Solutions (OR)",
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        {
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        },
        {
          "name": "Healthy U",
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          "parent": "University of Utah Health",
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        },
        {
          "name": "Molina Healthcare of Utah",
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        },
        {
          "name": "SelectHealth",
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          "lobCode": "MCD",
          "parent": "Intermountain Healthcare",
          "pbm": "Express Scripts",
          "url": "https://selecthealth.org/",
          "turnaround": "Standard",
          "expedited": "Expedited",
          "goldCard": "⚠️ SB 274 transparency (Mar 2026 reporting) - no auto-exemption yet",
          "channel": "Preauth & Care Plan Tool"
        },
        {
          "name": "Aetna Medicare",
          "slug": "AETNACARE",
          "id": "UT-MA-AETNACARE",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "CVS Health",
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          "url": null,
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          "goldCard": null,
          "channel": null
        },
        {
          "name": "Humana",
          "slug": "HUMANA",
          "id": "UT-MA-HUMANA",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "Humana Inc.",
          "pbm": "Humana Pharmacy Solutions",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "SelectHealth",
          "slug": "SELECTHEALTH",
          "id": "UT-MA-SELECTHEALTH",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "Intermountain Healthcare",
          "pbm": "Express Scripts",
          "url": null,
          "turnaround": null,
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          "goldCard": null,
          "channel": null
        },
        {
          "name": "UnitedHealthcare",
          "slug": "UHC",
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          "lob": "MA",
          "lobCode": "MA",
          "parent": "UnitedHealth Group",
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          "url": null,
          "turnaround": null,
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        },
        {
          "name": "University of Utah Health Plans",
          "slug": "uuhp-ut",
          "id": "UT-COM-UUHP",
          "lob": "Medicaid/Commercial",
          "lobCode": "COM",
          "parent": "University of Utah",
          "pbm": "UUHP PBM",
          "url": "https://uuhealthplans.com/",
          "turnaround": "Standard",
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          "goldCard": null,
          "channel": "UUHP Portal"
        },
        {
          "name": "Noridian Healthcare Solutions (UT)",
          "slug": "noridian-jf-ut",
          "id": "UT-PARTB-NORIDIAN",
          "lob": "PARTB",
          "lobCode": "PARTB",
          "parent": "Noridian Healthcare Solutions",
          "pbm": null,
          "url": "https://med.noridianmedicare.com/",
          "turnaround": "LCD",
          "expedited": null,
          "goldCard": "N/A - Federal",
          "channel": "Noridian Portal"
        },
        {
          "name": "Utah CHIP - Molina",
          "slug": "molina-ut-chip",
          "id": "UT-CHIP-MOLINA",
          "lob": "CHIP",
          "lobCode": "CHIP",
          "parent": "Molina Healthcare",
          "pbm": "CVS Caremark",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Utah CHIP - SelectHealth",
          "slug": "selecthealth-ut-chip",
          "id": "UT-CHIP-SELECTHEALTH",
          "lob": "CHIP",
          "lobCode": "CHIP",
          "parent": "Intermountain Health",
          "pbm": "SelectHealth PBM",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Noridian Healthcare Solutions (UT)",
          "slug": "NORIDIAN",
          "id": "UT-MAC-NORIDIAN",
          "lob": "Medicare MAC",
          "lobCode": "MAC",
          "parent": "Noridian",
          "pbm": "N/A - Medical Benefit",
          "url": "https://med.noridianmedicare.com/",
          "turnaround": "N/A - Post-service",
          "expedited": "N/A - Post-service",
          "goldCard": "N/A - Federal Medicare",
          "channel": "Claims-based / LCD compliance"
        },
        {
          "name": "SelectHealth",
          "slug": "SELECTHEALTH",
          "id": "UT-COM-SELECTHEALTH",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "Intermountain Health",
          "pbm": null,
          "url": "https://selecthealth.org/",
          "turnaround": "7 days",
          "expedited": "72 hours",
          "goldCard": null,
          "channel": null
        },
        {
          "name": "SelectHealth",
          "slug": "SELECT",
          "id": "UT-COM-SELECT",
          "lob": "COM",
          "lobCode": "COM",
          "parent": null,
          "pbm": null,
          "url": null,
          "turnaround": null,
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          "goldCard": null,
          "channel": null
        },
        {
          "name": "Healthy U (Medicaid)",
          "slug": "HEALTHYU",
          "id": "UT-MCD-HEALTHYU",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": null,
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          "url": null,
          "turnaround": null,
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          "goldCard": null,
          "channel": null
        },
        {
          "name": "GlobalHealth",
          "slug": "GLOBALHEALTH",
          "id": "UT-COM-GLOBALHEALTH",
          "lob": "COM",
          "lobCode": "COM",
          "parent": null,
          "pbm": null,
          "url": null,
          "turnaround": null,
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          "goldCard": null,
          "channel": null
        }
      ],
      "HI": [
        {
          "name": "Hawaii Medical Service Association (HMSA)",
          "slug": "HMSA",
          "id": "HI-COM-HMSA",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "HMSA (BCBS)",
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          "url": null,
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        },
        {
          "name": "Kaiser Permanente",
          "slug": "KAISER",
          "id": "HI-COM-KAISER",
          "lob": "COM",
          "lobCode": "COM",
          "parent": "Kaiser Foundation Health Plan",
          "pbm": "Kaiser Permanente (Internal)/MedImpact",
          "url": null,
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        },
        {
          "name": "UnitedHealthcare",
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          "lob": "COM",
          "lobCode": "COM",
          "parent": "UnitedHealth Group",
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          "url": null,
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        },
        {
          "name": "AlohaCare",
          "slug": "ALOHA",
          "id": "HI-MCD-ALOHA",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "AlohaCare",
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          "url": null,
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        },
        {
          "name": "Hawaii Medical Service Association (HMSA)",
          "slug": "HMSA",
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          "lobCode": "MCD",
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          "url": null,
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          "channel": null
        },
        {
          "name": "Kaiser Foundation Health Plan Hawaii",
          "slug": "KAISER",
          "id": "HI-MCD-KAISER",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "Kaiser Permanente",
          "pbm": "Kaiser Permanente (Internal)",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Ohana Health Plan",
          "slug": "OHANA",
          "id": "HI-MCD-OHANA",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "Centene",
          "pbm": "Envolve Pharmacy Solutions",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "UnitedHealthcare Community Plan Hawaii",
          "slug": "UHC",
          "id": "HI-MCD-UHC",
          "lob": "MCD",
          "lobCode": "MCD",
          "parent": "UnitedHealth Group",
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          "url": null,
          "turnaround": null,
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          "channel": null
        },
        {
          "name": "AlohaCare",
          "slug": "ALOHA",
          "id": "HI-MA-ALOHA",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "AlohaCare",
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          "url": null,
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          "channel": null
        },
        {
          "name": "HMSA (Hawaii Medical Service Association)",
          "slug": "HMSA",
          "id": "HI-MA-HMSA",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "HMSA",
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          "url": null,
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        },
        {
          "name": "Humana",
          "slug": "HUMANA",
          "id": "HI-MA-HUMANA",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "Humana Inc.",
          "pbm": "Humana Pharmacy Solutions",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Kaiser Permanente",
          "slug": "KAISER",
          "id": "HI-MA-KAISER",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "Kaiser Foundation Health Plan",
          "pbm": "Kaiser Permanente (Internal)/MedImpact",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "UnitedHealthcare",
          "slug": "UHC",
          "id": "HI-MA-UHC",
          "lob": "MA",
          "lobCode": "MA",
          "parent": "UnitedHealth Group",
          "pbm": "OptumRx",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "AlohaCare Hawaii",
          "slug": "alohacare-hi",
          "id": "HI-MCD-ALOHACARE",
          "lob": "Medicaid/Medicare SNP",
          "lobCode": "MCD",
          "parent": "AlohaCare",
          "pbm": "AlohaCare PBM",
          "url": "https://www.alohacare.org/",
          "turnaround": "Standard",
          "expedited": "Expedited",
          "goldCard": "N/A - Medicaid",
          "channel": "AlohaCare Portal"
        },
        {
          "name": "Noridian Healthcare Solutions (HI)",
          "slug": "noridian-je-hi",
          "id": "HI-PARTB-NORIDIAN",
          "lob": "PARTB",
          "lobCode": "PARTB",
          "parent": "Noridian",
          "pbm": null,
          "url": "https://med.noridianmedicare.com/",
          "turnaround": "LCD",
          "expedited": null,
          "goldCard": "N/A - Federal",
          "channel": "Noridian Portal"
        },
        {
          "name": "Hawaii QUEST Integration Kids - HMSA",
          "slug": "hmsa-hi-chip",
          "id": "HI-CHIP-HMSA",
          "lob": "CHIP",
          "lobCode": "CHIP",
          "parent": "HMSA",
          "pbm": "CVS Caremark",
          "url": null,
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          "goldCard": null,
          "channel": null
        },
        {
          "name": "Hawaii QUEST Integration Kids - Kaiser",
          "slug": "kaiser-hi-chip",
          "id": "HI-CHIP-KAISER",
          "lob": "CHIP",
          "lobCode": "CHIP",
          "parent": "Kaiser Permanente",
          "pbm": "Kaiser PBM",
          "url": null,
          "turnaround": null,
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          "goldCard": null,
          "channel": null
        },
        {
          "name": "Hawaii QUEST Integration Kids - AlohaCare",
          "slug": "alohacare-hi-chip",
          "id": "HI-CHIP-ALOHACARE",
          "lob": "CHIP",
          "lobCode": "CHIP",
          "parent": "AlohaCare",
          "pbm": "AlohaCare PBM",
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Noridian Healthcare Solutions (HI)",
          "slug": "NORIDIAN",
          "id": "HI-MAC-NORIDIAN",
          "lob": "Medicare MAC",
          "lobCode": "MAC",
          "parent": "Noridian",
          "pbm": "N/A - Medical Benefit",
          "url": "https://med.noridianmedicare.com/",
          "turnaround": "N/A - Post-service",
          "expedited": "N/A - Post-service",
          "goldCard": "N/A - Federal Medicare",
          "channel": "Claims-based / LCD compliance"
        },
        {
          "name": "HMSA",
          "slug": "HMSA-CLUSTER",
          "id": "HI-COM-HMSA-CLUSTER",
          "lob": "COM",
          "lobCode": "COM",
          "parent": null,
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          "url": null,
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          "channel": null
        }
      ],
      "ALL": [
        {
          "name": "Cigna (Cluster Headache)",
          "slug": "cigna-cluster",
          "id": "ALL-COM-CIGNA-CLUSTER",
          "lob": "Commercial",
          "lobCode": "COM",
          "parent": "The Cigna Group",
          "pbm": null,
          "url": null,
          "turnaround": null,
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          "goldCard": null,
          "channel": null
        },
        {
          "name": "UnitedHealthcare (Cluster Headache)",
          "slug": "uhc-cluster",
          "id": "ALL-COM-UHC-CLUSTER",
          "lob": "Commercial",
          "lobCode": "COM",
          "parent": "UnitedHealth Group",
          "pbm": null,
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Medicare Part B (Cluster Headache)",
          "slug": "medicare-partb-cluster",
          "id": "ALL-PARTB-CLUSTER",
          "lob": "PARTB",
          "lobCode": "PARTB",
          "parent": "CMS",
          "pbm": null,
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Aetna (National)",
          "slug": "AETNA",
          "id": "ALL-COM-AETNA",
          "lob": "COM",
          "lobCode": "COM",
          "parent": null,
          "pbm": null,
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Anthem/Elevance (National)",
          "slug": "ANTHEM",
          "id": "ALL-COM-ANTHEM",
          "lob": "COM",
          "lobCode": "COM",
          "parent": null,
          "pbm": null,
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Centene/Ambetter (National)",
          "slug": "CENTENE",
          "id": "ALL-COM-CENTENE",
          "lob": "COM",
          "lobCode": "COM",
          "parent": null,
          "pbm": null,
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Cigna (National)",
          "slug": "CIGNA",
          "id": "ALL-COM-CIGNA",
          "lob": "COM",
          "lobCode": "COM",
          "parent": null,
          "pbm": null,
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Humana (National)",
          "slug": "HUMANA",
          "id": "ALL-COM-HUMANA",
          "lob": "COM",
          "lobCode": "COM",
          "parent": null,
          "pbm": null,
          "url": null,
          "turnaround": null,
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          "goldCard": null,
          "channel": null
        },
        {
          "name": "Kaiser Permanente (National)",
          "slug": "KAISER",
          "id": "ALL-COM-KAISER",
          "lob": "COM",
          "lobCode": "COM",
          "parent": null,
          "pbm": null,
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        },
        {
          "name": "Molina Healthcare (National)",
          "slug": "MOLINA",
          "id": "ALL-COM-MOLINA",
          "lob": "COM",
          "lobCode": "COM",
          "parent": null,
          "pbm": null,
          "url": null,
          "turnaround": null,
          "expedited": null,
          "goldCard": null,
          "channel": null
        }
      ]
    },
    "payer_policies": {
      "PA-COM-HIGHBCBS": {
        "Gepants (Acute)": {
          "state": "PA",
          "payerName": "Highmark Blue Cross Blue Shield",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 triptans from different chemical families (sulfonamide: sumatriptan/naratriptan vs indole: rizatriptan/zolmitriptan),≥4 weeks each unless early discontinuation for documented adverse effects,N/A",
          "step1Duration": null,
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Standard QL",
          "contraBypass": "Yes - CV risk factors (uncontrolled HTN, CAD, CVD) qualify immediately without triptan trial; contraindication to vasoconstrictive agents",
          "goldCardAvail": "Act 146 (2026 measurement year)",
          "goldCardThresh": "≥90% approval; exemptions begin 1/1/2027",
          "policyId": "Policy I-11-042",
          "sourceDoc": "Pennsylvania_2026_PA_Audit",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "CGRP mAbs (SC)": {
          "state": "PA",
          "payerName": "Highmark Blue Cross Blue Shield",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 distinct oral preventive classes (beta-blockers, anticonvulsants, TCAs, SNRIs) at therapeutic doses (propranolol ≥80mg, topiramate ≥100mg, amitriptyline ≥50mg)",
          "step1Duration": "≥8 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Aimovig/Ajovy/Emgality; failure = <50% reduction in monthly migraine days OR intolerable side effects",
          "contraBypass": "Yes - documented contraindications: depression (TCA unsafe); cognitive impairment (topiramate); CV contraindication (beta-blockers); sedation impacting occupation",
          "goldCardAvail": "Act 146 (2026 measurement year)",
          "goldCardThresh": "≥90% approval; exemptions begin 1/1/2027",
          "policyId": "Policy I-11-042",
          "sourceDoc": "Q1-2026-Policy-Refresh",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "Concurrent use of distinct CGRP inhibitors requires prescriber attestation that clinical benefits outweigh risks."
        },
        "Neurotoxins": {
          "state": "PA",
          "payerName": "Highmark Blue Cross Blue Shield",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes (same as CGRP requirement); NOTE: does NOT require CGRP mAb failure before Botox - considered equivalent Tier 3 options,≥8 weeks each",
          "step1Duration": null,
          "step2Req": null,
          "step2Duration": "Chronic Migraine (≥15 HA days/mo for ≥3 months",
          "quantityLimit": " ≥8 days with migraine features)",
          "contraBypass": "Yes - oral preventive contraindications",
          "goldCardAvail": "Act 146 (2026 measurement year)",
          "goldCardThresh": "≥90% approval; exemptions begin 1/1/2027",
          "policyId": "Policy I-200-005",
          "sourceDoc": "Pennsylvania_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        },
        "CGRP mAbs (IV)": {
          "state": "PA",
          "payerName": "Highmark Blue Cross Blue Shield",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (IV)",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "≥8 weeks each",
          "step2Req": "PA Required",
          "step2Duration": "Documented",
          "quantityLimit": "J3032; Medical Benefit",
          "contraBypass": "Yes - inability to self-inject; oral preventive contraindications",
          "goldCardAvail": "Act 146 (2026 measurement year)",
          "goldCardThresh": "≥90% approval; exemptions begin 1/1/2027",
          "policyId": "Policy I-11-042",
          "sourceDoc": "Pennsylvania_2026_PA_Audit",
          "denialCode": "DENY-GOLD-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Gepants (Preventive)": {
          "state": "PA",
          "payerName": "Highmark Blue Cross Blue Shield",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Preventive)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "Fail injectable CGRP (Aimovig/Ajovy)",
          "step1Duration": "≥8 weeks",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "30 tabs/30 days",
          "contraBypass": "Yes - needle phobia; severe arthritis; tremor; anxiety; elderly/disabled alone",
          "goldCardAvail": "No",
          "goldCardThresh": null,
          "policyId": null,
          "sourceDoc": "Pennsylvania_2026_PA_Audit.docx",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "Injectable failure step with documented bypass options"
        }
      },
      "PA-COM-IBX": {
        "Gepants (Acute)": {
          "state": "PA",
          "payerName": "Independence Blue Cross",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 triptans OR documented contraindication; IBX accepts same-class trials if justified (e.g., two sumatriptan formulations for tolerability)",
          "step1Duration": "≥3 separate migraine episodes treated with each triptan",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Standard QL",
          "contraBypass": "Yes - CV contraindication; accepts same-class trials with justification",
          "goldCardAvail": "Act 146 (2026 measurement year)",
          "goldCardThresh": "≥90% approval; exemptions begin 1/1/2027",
          "policyId": "IBX Gepants Policy effe86e1",
          "sourceDoc": "Pennsylvania_2026_PA_Audit",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "CGRP mAbs (SC)": {
          "state": "PA",
          "payerName": "Independence Blue Cross",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 conventional oral preventives from different classes; IBX UNIQUELY allows SNRIs (venlafaxine, duloxetine) to count as one of two required classes",
          "step1Duration": "≥6 weeks each (SHORTER than Highmark 8-week)",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Standard criteria",
          "contraBypass": "Yes - teratogenic; CV contraindication; documented intolerance",
          "goldCardAvail": "Act 146 (2026 measurement year)",
          "goldCardThresh": "≥90% approval; exemptions begin 1/1/2027",
          "policyId": "IBX CGRP Policy",
          "sourceDoc": "Pennsylvania_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Neurotoxins": {
          "state": "PA",
          "payerName": "Independence Blue Cross",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventives",
          "step1Duration": "≥6 weeks each (shorter than Highmark)",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Chronic Migraine (≥15 HA days/mo for ≥3 months); REQUIRES headache diary documentation for 3-month period prior to PA submission",
          "contraBypass": "Yes - oral preventive contraindications",
          "goldCardAvail": "Act 146 (2026 measurement year)",
          "goldCardThresh": "≥90% approval; exemptions begin 1/1/2027",
          "policyId": "IBX Botulinum Toxins Form",
          "sourceDoc": "Pennsylvania_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        },
        "CGRP mAbs (IV)": {
          "state": "PA",
          "payerName": "Independence Blue Cross",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (IV)",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventives",
          "step1Duration": "≥6 weeks each",
          "step2Req": "PA Required",
          "step2Duration": "Documented",
          "quantityLimit": "J3032; Medical Benefit",
          "contraBypass": "Yes - inability to self-inject",
          "goldCardAvail": "Act 146 (2026 measurement year)",
          "goldCardThresh": "≥90% approval; exemptions begin 1/1/2027",
          "policyId": "IBX Medical Policy",
          "sourceDoc": "Pennsylvania_2026_PA_Audit",
          "denialCode": "DENY-GOLD-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Gepants (Preventive)": {
          "state": "PA",
          "payerName": "Independence Blue Cross",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Preventive)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "Fail injectable CGRP (Aimovig/Ajovy)",
          "step1Duration": "≥6 weeks",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "30 tabs/30 days",
          "contraBypass": "Yes - needle phobia; severe arthritis; tremor; anxiety; elderly/disabled alone",
          "goldCardAvail": "No",
          "goldCardThresh": null,
          "policyId": null,
          "sourceDoc": "Pennsylvania_2026_PA_Audit.docx",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "Injectable failure step with documented bypass options"
        }
      },
      "PA-COM-UPMC": {
        "Gepants (Acute)": {
          "state": "PA",
          "payerName": "UPMC Health Plan",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 DIFFERENT triptans (explicitly requires chemical class distinction)",
          "step1Duration": "≥4 weeks each unless early discontinuation documented",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Standard QL",
          "contraBypass": "Yes - CV contraindication; contraindication to vasoconstrictive agents",
          "goldCardAvail": "Act 146 (2026 measurement year)",
          "goldCardThresh": "≥90% approval; exemptions begin 1/1/2027",
          "policyId": "UPMC Pharmacy PA Criteria",
          "sourceDoc": "Pennsylvania_2026_PA_Audit",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "CGRP mAbs (SC)": {
          "state": "PA",
          "payerName": "UPMC Health Plan",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 conventional preventives from different classes (beta-blockers, anticonvulsants, TCAs explicitly listed as preferred first-line)",
          "step1Duration": "≥8 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Standard criteria",
          "contraBypass": "Yes - documented contraindications/intolerances",
          "goldCardAvail": "Act 146 (2026 measurement year)",
          "goldCardThresh": "≥90% approval; exemptions begin 1/1/2027",
          "policyId": "UPMC CGRP Policy",
          "sourceDoc": "Q1-2026-Policy-Refresh",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null,
          "siteOfCare": "Medical Benefit Required"
        },
        "Neurotoxins": {
          "state": "PA",
          "payerName": "UPMC Health Plan",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventives",
          "step1Duration": "≥8 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Chronic Migraine (≥15 HA days/mo for ≥3 months); accepts EITHER headache diary OR physician attestation in clinical notes",
          "contraBypass": "Yes - oral preventive contraindications",
          "goldCardAvail": "Act 146 (2026 measurement year)",
          "goldCardThresh": "≥90% approval; exemptions begin 1/1/2027",
          "policyId": "UPMC Botox Policy",
          "sourceDoc": "Pennsylvania_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        },
        "CGRP mAbs (IV)": {
          "state": "PA",
          "payerName": "UPMC Health Plan",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (IV)",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventives",
          "step1Duration": "≥8 weeks each",
          "step2Req": "PA Required",
          "step2Duration": "Documented",
          "quantityLimit": "J3032; Medical Benefit",
          "contraBypass": "Yes - inability to self-inject",
          "goldCardAvail": "Act 146 (2026 measurement year)",
          "goldCardThresh": "≥90% approval; exemptions begin 1/1/2027",
          "policyId": "UPMC Medical Policy",
          "sourceDoc": "Pennsylvania_2026_PA_Audit",
          "denialCode": "DENY-GOLD-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "PA-MCD-UPMCHEALTH": {
        "Gepants (Acute)": {
          "state": "PA",
          "payerName": "UPMC For You",
          "payerType": "Medicaid MCO",
          "lob": "Medicaid Pharmacy",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 triptans from different chemical classes per PA DHS PDL (pharmacy CARVED OUT to state PDL),≥4-6 weeks each (adequate trial); failure = <50% reduction OR intolerable effects OR contraindication (CV disease, hemiplegic/basilar migraine),N/A,N/A,PA DHS PDL governs; different from UPMC Health Plan commercial",
          "step1Duration": null,
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": null,
          "contraBypass": "Yes - CV contraindication to vasoconstrictive agents (uncontrolled HTN, ischemic heart, PVD, CVD, hemiplegic/basilar migraine)",
          "goldCardAvail": "Act 146 (Medicaid)",
          "goldCardThresh": null,
          "policyId": "PA DHS Statewide PDL",
          "sourceDoc": "Pennsylvania_2026_PA_Audit",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "CGRP mAbs (SC)": {
          "state": "PA",
          "payerName": "UPMC For You",
          "payerType": "Medicaid MCO",
          "lob": "Medicaid Pharmacy",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 distinct oral preventive classes per PA DHS PDL (beta-blockers: propranolol/metoprolol, anticonvulsants: topiramate/valproic acid, TCAs: amitriptyline/nortriptyline) at therapeutic doses",
          "step1Duration": "≥8 weeks each unless discontinued early for documented adverse effects; failure = <50% reduction OR intolerable adverse effects",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "PA DHS PDL governs; most stringent in state",
          "contraBypass": "Yes - documented contraindications per PA DHS PDL bypass criteria",
          "goldCardAvail": "Act 146 (Medicaid)",
          "goldCardThresh": null,
          "policyId": "PA DHS Statewide PDL",
          "sourceDoc": "Pennsylvania_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Neurotoxins": {
          "state": "PA",
          "payerName": "UPMC For You",
          "payerType": "Medicaid MCO",
          "lob": "Medical Benefit",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventives per UPMC For You medical policy (NOT commercial UPMC Health Plan policy),≥8 weeks each",
          "step1Duration": null,
          "step2Req": null,
          "step2Duration": "Chronic Migraine per ICHD-3 (≥15 HA days/mo for ≥3 consecutive months",
          "quantityLimit": " ≥8 days with migraine features); must document via headache diary or clinical note for 3-month period preceding PA",
          "contraBypass": "Yes - oral preventive contraindications",
          "goldCardAvail": "Act 146 (Medicaid)",
          "goldCardThresh": null,
          "policyId": "UPMC For You Medical Policy",
          "sourceDoc": "Pennsylvania_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        },
        "CGRP mAbs (IV)": {
          "state": "PA",
          "payerName": "UPMC For You",
          "payerType": "Medicaid MCO",
          "lob": "Medical Benefit",
          "drugClass": "CGRP mAbs (IV)",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventives per UPMC For You policy",
          "step1Duration": "≥8 weeks each",
          "step2Req": "Medical PA Required",
          "step2Duration": "Documented",
          "quantityLimit": "J3032; Medical Benefit under MCO",
          "contraBypass": "Yes - inability to self-inject",
          "goldCardAvail": "Act 146 (Medicaid)",
          "goldCardThresh": null,
          "policyId": "UPMC For You Medical Policy",
          "sourceDoc": "Pennsylvania_2026_PA_Audit",
          "denialCode": "DENY-GOLD-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "PA-MCD-AMERIHEALTH": {
        "CGRP mAbs (SC)": {
          "state": "PA",
          "payerName": "AmeriHealth Caritas Pennsylvania",
          "payerType": "Medicaid MCO",
          "lob": "Medicaid Pharmacy",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes per PA DHS PDL",
          "step1Duration": "≥8 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "PA DHS PDL governs; dedicated Migraine Prevention Agents PA form available",
          "contraBypass": "Yes - documented contraindications",
          "goldCardAvail": "Act 146 (Medicaid)",
          "goldCardThresh": null,
          "policyId": "AmeriHealth Migraine Prevention Form",
          "sourceDoc": "Pennsylvania_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Gepants (Acute)": {
          "state": "PA",
          "payerName": "AmeriHealth Caritas Pennsylvania",
          "payerType": "Medicaid MCO",
          "lob": "Medicaid Pharmacy",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 triptans per PA DHS PDL (pharmacy carved out)",
          "step1Duration": "≥4-6 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "PA DHS PDL governs",
          "contraBypass": "Yes - CV contraindication",
          "goldCardAvail": "Act 146 (Medicaid)",
          "goldCardThresh": null,
          "policyId": "PA DHS PDL",
          "sourceDoc": "Pennsylvania_2026_PA_Audit",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Neurotoxins": {
          "state": "PA",
          "payerName": "AmeriHealth Caritas Pennsylvania",
          "payerType": "Medicaid MCO",
          "lob": "Medical Benefit",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventives",
          "step1Duration": "≥8 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Chronic Migraine per ICHD-3",
          "contraBypass": "Yes - oral preventive contraindications",
          "goldCardAvail": "Act 146 (Medicaid)",
          "goldCardThresh": null,
          "policyId": "AmeriHealth Medical Policy",
          "sourceDoc": "Pennsylvania_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        }
      },
      "PA-MAC-NOVITAS": {
        "Neurotoxins": {
          "state": "PA",
          "payerName": "Novitas Solutions",
          "payerType": "Medicare MAC",
          "lob": "Part B",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "Failed 'conventional methods' of treatment (best practice: ≥2 oral preventive classes documented),Documented in medical record",
          "step1Duration": null,
          "step2Req": null,
          "step2Duration": "LCD L38809/DL39909; Chronic Migraine (≥15 HA days/mo for >3 months",
          "quantityLimit": " ≥8 migraine days); Episodic NOT covered; injection sites + dosages must be documented; JW modifier for waste MANDATORY; Original Medicare = post-service prepayment audits (no pre-service PA); MA plans DO require pre-service PA",
          "contraBypass": "Yes - documented conventional therapy failures",
          "goldCardAvail": "No - Federal Medicare",
          "goldCardThresh": null,
          "policyId": "LCD L38809/DL39909",
          "sourceDoc": "Q1-2026-Policy-Refresh",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "Documentation of clinical effectiveness of two consecutive prior treatments"
        },
        "CGRP mAbs (IV)": {
          "state": "PA",
          "payerName": "Novitas Solutions",
          "payerType": "Medicare MAC",
          "lob": "Part B",
          "drugClass": "CGRP mAbs (IV)",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "Per LCD requirements",
          "step1Duration": "Documented",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "J3032; Chronic Migraine; Medical Benefit; Jurisdiction L",
          "contraBypass": "Yes - inability to self-inject",
          "goldCardAvail": "No - Federal Medicare",
          "goldCardThresh": null,
          "policyId": "LCD L38809/DL39909",
          "sourceDoc": "Pennsylvania_2026_PA_Audit",
          "denialCode": "DENY-QL-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "DE-COM-HIGHBCBS": {
        "Gepants (Acute)": {
          "state": "DE",
          "payerName": "Highmark BCBS DE",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 triptans",
          "step1Duration": "Trial required",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Ubrelvy 16/30d, Nurtec 8/30d",
          "contraBypass": "Yes - CV contraindication",
          "goldCardAvail": "Yes (Voluntary)",
          "goldCardThresh": "90% approval rate",
          "policyId": "I-11-042",
          "sourceDoc": "Delaware_2026_PA_Audit",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "CGRP mAbs (SC)": {
          "state": "DE",
          "payerName": "Highmark BCBS DE",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "1 agent from 2 different classes (beta-blocker, antidepressant, anti-epileptic, ARB)",
          "step1Duration": "≥8 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Monthly supply",
          "contraBypass": "Yes - teratogenic; CV per 18 Del. C. § 3381",
          "goldCardAvail": "Yes (Voluntary)",
          "goldCardThresh": "90% approval rate",
          "policyId": "I-200-005",
          "sourceDoc": "Delaware_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Neurotoxins": {
          "state": "DE",
          "payerName": "Highmark BCBS DE",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 prophylactic classes",
          "step1Duration": "≥6 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "155 units/12 weeks",
          "contraBypass": "Yes",
          "goldCardAvail": "Yes (Voluntary)",
          "goldCardThresh": "90% approval rate",
          "policyId": "I-11-042",
          "sourceDoc": "Delaware_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        },
        "CGRP mAbs (IV)": {
          "state": "DE",
          "payerName": "Highmark BCBS DE",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (IV)",
          "medCategory": "Preventive IV",
          "stepTherapyRequired": "Yes",
          "step1Req": "Must justify why SubQ CGRP not appropriate",
          "step1Duration": null,
          "step2Req": "Fail SubQ CGRP or document barrier",
          "step2Duration": null,
          "quantityLimit": "Quarterly infusion",
          "contraBypass": "Yes - needle phobia; inability to self-inject",
          "goldCardAvail": "Yes (Voluntary)",
          "goldCardThresh": "90% approval rate",
          "policyId": "I-222-007",
          "sourceDoc": "Delaware_2026_PA_Audit",
          "denialCode": "DENY-GOLD-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "DE-MCD-AMERIHEALTH": {
        "CGRP mAbs (SC)": {
          "state": "DE",
          "payerName": "AmeriHealth Caritas Delaware",
          "payerType": "Medicaid MCO",
          "lob": "Medicaid",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 PDL agents (may be same class unlike Highmark); pharmacy fill history required",
          "step1Duration": "4 weeks per category at minimum effective doses",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "DMAP PDL; Emgality/Ajovy often preferred; Brand over Generic = DAW 1; SDOH leverage viable",
          "contraBypass": "Yes - teratogenic; cognitive; respiratory",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "DMAP PDL",
          "sourceDoc": "Q1-2026-Policy-Refresh",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "DE-MCD-DELFIRST": {
        "Gepants (Acute)": {
          "state": "DE",
          "payerName": "Delaware First Health",
          "payerType": "Medicaid MCO",
          "lob": "Medicaid",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 triptans",
          "step1Duration": "Trial required",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "PDL limits",
          "contraBypass": "Yes per 18 Del. C. § 3381",
          "goldCardAvail": "No",
          "goldCardThresh": null,
          "policyId": "DE Medicaid PDL",
          "sourceDoc": "Delaware_2026_PA_Audit",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "DE-COM-CIGNA": {
        "Gepants (Acute)": {
          "state": "DE",
          "payerName": "Cigna",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "Triptan prerequisite steps reduced from 2 to 1 for Individual and Family Plans for acute migraine treatment. Preventive episodic migraine preferred product criteria removed.",
          "step1Duration": "Trial required",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Plan dependent",
          "contraBypass": "Yes - CV contraindication",
          "goldCardAvail": "Yes (National Gold Card)",
          "goldCardThresh": "Voluntary program",
          "policyId": "Cigna Medical Policy",
          "sourceDoc": "Q1-2026-Policy-Refresh",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "CGRP mAbs (SC)": {
          "state": "DE",
          "payerName": "Cigna",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "CGRP-targeting therapies (Aimovig, Ajovy, Emgality, Vyepti, Nurtec ODT, Qulipta) now considered first-line for migraine prevention alongside traditional therapies. No requirement for prior failure of other preventive medication classes. Step therapy requirement removed for CGRP mAbs as preventive therapy.",
          "step1Duration": "CGRP-targeting therapies (Aimovig, Ajovy, Emgality, Vyepti, Nurtec ODT, Qulipta) now considered first-line for migraine prevention alongside traditional therapies. No requirement for prior failure of other preventive medication classes. Step therapy requirement removed for CGRP mAbs as preventive therapy.",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Monthly supply",
          "contraBypass": "Yes",
          "goldCardAvail": "Yes (National Gold Card)",
          "goldCardThresh": "Voluntary program",
          "policyId": "Cigna Medical Policy",
          "sourceDoc": "Q1-2026-Policy-Refresh",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": "8.0",
          "episodicNotes": "CGRP-targeting therapies (Aimovig, Ajovy, Emgality, Vyepti, Nurtec ODT, Qulipta) now considered first-line for migraine prevention alongside traditional therapies. No requirement for prior failure of other preventive medication classes. Step therapy requirement removed for CGRP mAbs as preventive th"
        }
      },
      "DE-MAC-NOVITAS": {
        "Neurotoxins": {
          "state": "DE",
          "payerName": "Novitas Solutions",
          "payerType": "Medicare MAC",
          "lob": "Part B",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 classes; headache diary required",
          "step1Duration": "Trial required",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "155 units/12 weeks",
          "contraBypass": "Yes",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "LCD L38809",
          "sourceDoc": "Delaware_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        }
      },
      "AL-COM-UHC": {
        "Gepants (Acute)": {
          "state": "AL",
          "payerName": "UnitedHealthcare",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 triptans",
          "step1Duration": "≥30 days per agent",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Nurtec 8/30d, Ubrelvy 16/30d",
          "contraBypass": "Yes - CV contraindication",
          "goldCardAvail": "Yes (National Gold Card)",
          "goldCardThresh": "≥92% approval x 2 years",
          "policyId": "UHC CGRP Policy",
          "sourceDoc": "Alabama_2026_PA_Audit",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "CGRP mAbs (SC)": {
          "state": "AL",
          "payerName": "UnitedHealthcare",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventives (beta-blocker, topiramate, divalproex, amitriptyline/venlafaxine)",
          "step1Duration": "≥2 months each",
          "step2Req": "Fail Aimovig OR Emgality for non-preferred (Ajovy)",
          "step2Duration": null,
          "quantityLimit": "Monthly supply",
          "contraBypass": "Yes - teratogenic; CV",
          "goldCardAvail": "Yes (National Gold Card)",
          "goldCardThresh": "≥92% approval x 2 years",
          "policyId": "UHC CGRP Policy",
          "sourceDoc": "Alabama_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Neurotoxins": {
          "state": "AL",
          "payerName": "UnitedHealthcare",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "Check Gold Card status first - Advance Notification only if Gold Carded",
          "step1Duration": null,
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "155 units/12 weeks",
          "contraBypass": "Yes",
          "goldCardAvail": "Yes (National Gold Card)",
          "goldCardThresh": "≥92% approval x 2 years",
          "policyId": "UHC Medical Policy",
          "sourceDoc": "Alabama_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        }
      },
      "AL-COM-BCBSAL": {
        "CGRP mAbs (SC)": {
          "state": "AL",
          "payerName": "Blue Cross Blue Shield Alabama",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 different oral preventive classes",
          "step1Duration": "≥8 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "⚠️ 87% market share = BCBSAL denial = statewide denial; Source+Rx formulary; Prime Therapeutics; ⚠️ 'Consensus Agreement' = No AI Denial + quasi-Gold Card",
          "contraBypass": "Yes - teratogenic; cognitive; respiratory",
          "goldCardAvail": "✓ Voluntary Consensus Agreement",
          "goldCardThresh": "90%",
          "policyId": "Source+Rx Formulary",
          "sourceDoc": "Alabama_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Gepants (Acute)": {
          "state": "AL",
          "payerName": "Blue Cross Blue Shield Alabama",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 triptans",
          "step1Duration": "Documented",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Prime Therapeutics logic; No AI Denial rule = human review guaranteed",
          "contraBypass": "Yes - CV contraindication",
          "goldCardAvail": "✓ Voluntary Consensus Agreement",
          "goldCardThresh": "90%",
          "policyId": "Source+Rx Formulary",
          "sourceDoc": "Alabama_2026_PA_Audit",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Gepants (Preventive)": {
          "state": "AL",
          "payerName": "BCBS Alabama",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Preventive)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "Similar to CGRP mAb criteria",
          "step1Duration": "≥8 weeks",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "16 tabs/30 days",
          "contraBypass": "Yes - standard",
          "goldCardAvail": "No",
          "goldCardThresh": null,
          "policyId": null,
          "sourceDoc": "Alabama_2026_PA_Audit.docx",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "Branded preventive option"
        }
      },
      "AL-MAC-PALMETTO": {
        "Neurotoxins": {
          "state": "AL",
          "payerName": "Palmetto GBA",
          "payerType": "Medicare MAC",
          "lob": "Part B",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 conventional preventives; ICD-10 G43.7xx ONLY",
          "step1Duration": "Adequate trial",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "155 units/12 weeks; JW modifier required for waste",
          "contraBypass": "Yes",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "LCD DL39909 (eff. 2/15/2026)",
          "sourceDoc": "Alabama_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        }
      },
      "MI-COM-MICHBCBS": {
        "CGRP mAbs (SC)": {
          "state": "MI",
          "payerName": "Blue Cross Blue Shield MI",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "≥8 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Monthly supply",
          "contraBypass": "Yes - teratogenic; CV",
          "goldCardAvail": "No",
          "goldCardThresh": null,
          "policyId": "BCBSMI Medical Policy",
          "sourceDoc": "Michigan_2026_PA_Audit_Strategy",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "MI-COM-PRIORITY": {
        "Gepants (Acute)": {
          "state": "MI",
          "payerName": "Priority Health",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 triptans",
          "step1Duration": "Trial required",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Plan dependent",
          "contraBypass": "Yes - CV contraindication",
          "goldCardAvail": "Yes (Priority Gold Card)",
          "goldCardThresh": "High approval rate",
          "policyId": "Priority Health Policy",
          "sourceDoc": "Michigan_2026_PA_Audit_Strategy",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "CGRP mAbs (SC)": {
          "state": "MI",
          "payerName": "Priority Health",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventives",
          "step1Duration": "Trial required",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Monthly supply",
          "contraBypass": "Yes; honors continuity of care",
          "goldCardAvail": "Yes (Priority Gold Card)",
          "goldCardThresh": "High approval rate",
          "policyId": "Priority Health Policy",
          "sourceDoc": "Michigan_2026_PA_Audit_Strategy",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Neurotoxins": {
          "state": "MI",
          "payerName": "Priority Health",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventives; no concurrent CGRP unless refractory appeal",
          "step1Duration": "Trial required",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "155 units/12 weeks",
          "contraBypass": "Yes",
          "goldCardAvail": "Yes (Priority Gold Card)",
          "goldCardThresh": "High approval rate",
          "policyId": "Priority Health Policy",
          "sourceDoc": "Michigan_2026_PA_Audit_Strategy",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        },
        "Gepants (Preventive)": {
          "state": "MI",
          "payerName": "Priority Health Michigan",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Preventive)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 preferred injectable CGRPs (Aimovig/Emgality)",
          "step1Duration": "Documented failures",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "⚠️ 'Step 3' - Qulipta positioned as third-line after injectable CGRPs",
          "contraBypass": "Yes - injection disability/phobia",
          "goldCardAvail": "⚠️ ASO excluded",
          "goldCardThresh": null,
          "policyId": "Priority Health Formulary",
          "sourceDoc": "Michigan_2026_PA_Audit",
          "denialCode": "DENY-QL-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "MI-COM-UHC": {
        "Gepants (Acute)": {
          "state": "MI",
          "payerName": "UnitedHealthcare",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "1-2 triptans (plan dependent)",
          "step1Duration": "≥30 days",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Nurtec 8/30d, Ubrelvy 16/30d",
          "contraBypass": "Yes - CV contraindication",
          "goldCardAvail": "Yes (National Gold Card)",
          "goldCardThresh": "≥92% approval x 2 years",
          "policyId": "UHC CGRP Policy",
          "sourceDoc": "Michigan_2026_PA_Audit_Strategy",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "CGRP mAbs (SC)": {
          "state": "MI",
          "payerName": "UnitedHealthcare",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes; Aimovig/Emgality preferred",
          "step1Duration": "≥6 weeks each",
          "step2Req": "Ajovy requires fail of Aimovig OR Emgality",
          "step2Duration": null,
          "quantityLimit": "Monthly supply",
          "contraBypass": "Yes",
          "goldCardAvail": "Yes (National Gold Card)",
          "goldCardThresh": "≥92% approval x 2 years",
          "policyId": "UHC CGRP Policy",
          "sourceDoc": "Michigan_2026_PA_Audit_Strategy",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Neurotoxins": {
          "state": "MI",
          "payerName": "UnitedHealthcare",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventives; strict 15 day documentation",
          "step1Duration": "Trial required",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "155 units/12 weeks",
          "contraBypass": "Yes",
          "goldCardAvail": "Yes (National Gold Card - CPT 64615)",
          "goldCardThresh": "≥92% approval x 2 years",
          "policyId": "UHC Medical Policy",
          "sourceDoc": "Michigan_2026_PA_Audit_Strategy",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        }
      },
      "ME-COM-ELEV": {
        "Gepants (Acute)": {
          "state": "ME",
          "payerName": "Anthem BCBS Maine",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 triptans",
          "step1Duration": "Trial required",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Plan dependent",
          "contraBypass": "Yes - CV contraindication",
          "goldCardAvail": "No state mandate",
          "goldCardThresh": null,
          "policyId": "Anthem CarelonRx",
          "sourceDoc": "Maine_2026_PA_Audit_Report",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "CGRP mAbs (SC)": {
          "state": "ME",
          "payerName": "Anthem BCBS Maine",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2-3 oral preventive classes (beta-blocker, TCA, anticonvulsant)",
          "step1Duration": "Trial required",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Monthly supply",
          "contraBypass": "Yes - teratogenic; CV; asthma",
          "goldCardAvail": "No state mandate",
          "goldCardThresh": null,
          "policyId": "Anthem CarelonRx",
          "sourceDoc": "Maine_2026_PA_Audit_Report",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": "8.0",
          "episodicNotes": "Anthem: Episodic (<8d) = 1 oral class; Episodic (≥8d) = same as chronic (1 oral class). More lenient than most payers for episodic."
        }
      },
      "ME-MCD-MAINECARE": {
        "Gepants (Acute)": {
          "state": "ME",
          "payerName": "MaineCare",
          "payerType": "Medicaid FFS",
          "lob": "Medicaid",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥1 triptan (PDL requirement)",
          "step1Duration": "Trial required",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "PDL limits",
          "contraBypass": "Yes - CV contraindication",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "MaineCare PDL",
          "sourceDoc": "Maine_2026_PA_Audit_Report",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "CGRP mAbs (SC)": {
          "state": "ME",
          "payerName": "MaineCare",
          "payerType": "Medicaid FFS",
          "lob": "Medicaid",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "Per PDL requirements",
          "step1Duration": "Trial required",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "PDL limits",
          "contraBypass": "Yes per 24-A MRSA §4304-B",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "MaineCare PDL",
          "sourceDoc": "Maine_2026_PA_Audit_Report",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Gepants (Preventive)": {
          "state": "ME",
          "payerName": "Maine Medicaid (MaineCare)",
          "payerType": "Medicaid FFS",
          "lob": "Medicaid",
          "drugClass": "Gepants (Preventive)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "Per state criteria",
          "step1Duration": "≥8 weeks",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "30 tabs/30 days",
          "contraBypass": "Yes - standard",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": null,
          "sourceDoc": "Maine_2026_PA_Audit_Report.md",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "FALLBACK - apply CGRP mAb criteria"
        }
      },
      "ME-COM-COMMHEALTH": {
        "Gepants (Acute)": {
          "state": "ME",
          "payerName": "Community Health Options",
          "payerType": "Commercial",
          "lob": "Exchange",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 triptans (Express Scripts)",
          "step1Duration": "Trial required",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Plan dependent",
          "contraBypass": "Yes - CV contraindication; CISP bypass available",
          "goldCardAvail": "No",
          "goldCardThresh": null,
          "policyId": "CHO/ESI Formulary",
          "sourceDoc": "Maine_2026_PA_Audit_Report",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "ME-COM-HARVARD": {
        "CGRP mAbs (SC)": {
          "state": "ME",
          "payerName": "Harvard Pilgrim",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "Trial required",
          "step2Req": "Ajovy EXCLUDED 2026",
          "step2Duration": null,
          "quantityLimit": "Monthly supply",
          "contraBypass": "Yes",
          "goldCardAvail": "No",
          "goldCardThresh": null,
          "policyId": "Point32Health Policy",
          "sourceDoc": "Maine_2026_PA_Audit_Report",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "ME-MAC-NGS": {
        "Neurotoxins": {
          "state": "ME",
          "payerName": "National Government Services",
          "payerType": "Medicare MAC",
          "lob": "Part B",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 conventional preventives; headache diary",
          "step1Duration": "2-month trial of at least one agent in two distinct classes",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "155 units/12 weeks; JZ modifier required",
          "contraBypass": "Yes",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "LCD L33646",
          "sourceDoc": "Q1-2026-Policy-Refresh",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        }
      },
      "NH-COM-ANTHEM": {
        "Neurotoxins": {
          "state": "NH",
          "payerName": "Anthem BCBS New Hampshire",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "≥8 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "155 units/12 weeks",
          "contraBypass": "Yes",
          "goldCardAvail": "No state mandate",
          "goldCardThresh": null,
          "policyId": "Carelon Medical",
          "sourceDoc": "New_Hampshire_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        },
        "Gepants (Acute)": {
          "state": "NH",
          "payerName": "Anthem BCBS New Hampshire",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 preferred triptans (Sumatriptan/Rizatriptan/Eletriptan/Naratriptan)",
          "step1Duration": "Documented (inadequate response within 2hrs or intolerance)",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "QL: 16 tabs/30d (Ubrelvy); 8 tabs/30d (Nurtec acute); Override: document 'Cluster-like features' or 'Menstrual Migraine'",
          "contraBypass": "Yes - CV contraindication ('Contraindication to Vasoconstrictive Agents'); Serotonin Syndrome risk (SSRI/SNRI)",
          "goldCardAvail": "⚠️ SB 561 'Deemed Approved'",
          "goldCardThresh": "2 biz days",
          "policyId": "Anthem Formulary",
          "sourceDoc": "New_Hampshire_2026_PA_Audit",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "CGRP mAbs (SC)": {
          "state": "NH",
          "payerName": "Anthem BCBS New Hampshire",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥1-2 oral preventive classes (Beta-blocker/Antiepileptic/TCA)",
          "step1Duration": "≥2 months each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "PREFERRED: Aimovig, Emgality (Tier 3); NON-PREFERRED: Ajovy, Vyepti; Vyepti requires SC failure unless needle phobia/dexterity documented",
          "contraBypass": "Yes - teratogenic; cognitive; respiratory; Needle Phobia (DSM-5); Dexterity/Cognitive Impairment; Gastroparesis (Vyepti bioavailability argument)",
          "goldCardAvail": "⚠️ SB 561 applies",
          "goldCardThresh": "2 biz days",
          "policyId": "Anthem Formulary",
          "sourceDoc": "New_Hampshire_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": "8.0",
          "episodicNotes": "Anthem: Episodic (<8d) = 1 oral class; Episodic (≥8d) = same as chronic (1 oral class). More lenient than most payers for episodic."
        },
        "Gepants (Preventive)": {
          "state": "NH",
          "payerName": "Anthem New Hampshire",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Preventive)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes (national baseline)",
          "step1Duration": "≥8 weeks",
          "step2Req": "Inferred: May require mAb step per national policy",
          "step2Duration": null,
          "quantityLimit": "30 tabs/30 days",
          "contraBypass": "Yes - standard CGRP bypasses",
          "goldCardAvail": "No",
          "goldCardThresh": null,
          "policyId": null,
          "sourceDoc": "NATIONAL_BASELINE",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "NATIONAL BASELINE - no state audit document"
        }
      },
      "NH-MCD-GRANITE": {
        "Gepants (Acute)": {
          "state": "NH",
          "payerName": "NH Healthy Families",
          "payerType": "Medicaid MCO",
          "lob": "Medicaid",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 triptans (Centene PDL)",
          "step1Duration": "Trial required",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "PDL limits",
          "contraBypass": "Yes - CV contraindication",
          "goldCardAvail": "No",
          "goldCardThresh": null,
          "policyId": "NH.PHAR.476",
          "sourceDoc": "New_Hampshire_2026_PA_Audit",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "CGRP mAbs (SC)": {
          "state": "NH",
          "payerName": "NH Healthy Families",
          "payerType": "Medicaid MCO",
          "lob": "Medicaid",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes (strict PDL)",
          "step1Duration": "Trial required",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "PDL limits",
          "contraBypass": "Yes",
          "goldCardAvail": "No",
          "goldCardThresh": null,
          "policyId": "Centene Policy",
          "sourceDoc": "New_Hampshire_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "NH-MAC-NGS": {
        "Neurotoxins": {
          "state": "NH",
          "payerName": "National Government Services",
          "payerType": "Medicare MAC",
          "lob": "Part B",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 conventional preventives",
          "step1Duration": "Adequate trial",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "155 units/12 weeks",
          "contraBypass": "Yes",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "LCD L33646",
          "sourceDoc": "New_Hampshire_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        }
      },
      "NY-MCD-NYRX": {
        "Gepants (Acute)": {
          "state": "NY",
          "payerName": "NYRx (New York State Medicaid)",
          "payerType": "Medicaid FFS",
          "lob": "Medicaid Pharmacy",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥1 triptan trial (failure/intolerance/contraindication),Per clinical judgment,N/A",
          "step1Duration": null,
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Nurtec ODT 18-24 doses/30-40d acute; 8 tabs/30d some contexts; Ubrelvy standard QL",
          "contraBypass": "Yes - CV contraindication to vasoconstrictive agents (CAD, uncontrolled HTN, PVD) bypasses triptan requirement immediately",
          "goldCardAvail": "N/A - State Medicaid",
          "goldCardThresh": null,
          "policyId": "NYRx PDL Clinical Criteria",
          "sourceDoc": "New_York_2026_PA_Audit",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "CGRP mAbs (SC)": {
          "state": "NY",
          "payerName": "NYRx (New York State Medicaid)",
          "payerType": "Medicaid FFS",
          "lob": "Medicaid Pharmacy",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes (Beta-blockers, Anticonvulsants, Antidepressants) - CAPPED at 2 per NY Chapter 20 Laws 2025",
          "step1Duration": "≤30 days or per evidence-based guidelines (NY law)",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Emgality 120mg PREFERRED; Nurtec ODT PREFERRED for episodic prevention (EOD dosing); Aimovig/Ajovy/Qulipta NON-PREFERRED require step through preferred",
          "contraBypass": "Yes - contraindication/harm; clinical ineffectiveness; stability/continuity of care; best interest (NY Ins Law §4903 override criteria)",
          "goldCardAvail": "N/A - State Medicaid",
          "goldCardThresh": null,
          "policyId": "NYRx PDL / NY Ins Law §4902",
          "sourceDoc": "New_York_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Gepants (Preventive)": {
          "state": "NY",
          "payerName": "NY Medicaid (NYRx)",
          "payerType": "Medicaid FFS",
          "lob": "Medicaid",
          "drugClass": "Gepants (Preventive)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "Trial of a preferred monoclonal antibody required",
          "step1Duration": "≥8 weeks",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "30 tabs/30 days",
          "contraBypass": "Yes - latex allergy; adverse reaction",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": null,
          "sourceDoc": "Q1-2026-Policy-Refresh",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "Non-Preferred - requires step through Nurtec ODT or Emgality"
        }
      },
      "NY-MCD-FIDELIS": {
        "Neurotoxins": {
          "state": "NY",
          "payerName": "Fidelis Care (Centene)",
          "payerType": "Medicaid MCO",
          "lob": "Medical Benefit",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes (Topiramate, Propranolol, Amitriptyline) - CAPPED at 2 per NY Chapter 20,≥2 months each (but ≤30 days if adverse event per NY law),N/A",
          "step1Duration": null,
          "step2Req": "155-200 units/12 weeks; Chronic Migraine (≥15 HA days/mo",
          "step2Duration": " ≥8 migraine days",
          "quantityLimit": " ≥4 hours duration) for ≥3 months; reauth requires ≥7 day reduction or functional improvement",
          "contraBypass": "Yes - cognitive slowing (topiramate); hypotension (beta-blockers); adverse event discontinuation valid regardless of duration per NY Ins Law §4902",
          "goldCardAvail": "N/A - Medicaid MCO",
          "goldCardThresh": null,
          "policyId": "Centene CP.MP.162/CP.FC.05",
          "sourceDoc": "New_York_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        },
        "CGRP mAbs (IV)": {
          "state": "NY",
          "payerName": "Fidelis Care (Centene)",
          "payerType": "Medicaid MCO",
          "lob": "Medical Benefit",
          "drugClass": "CGRP mAbs (IV)",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes,≥2 months each",
          "step1Duration": "≥1-2 SC CGRPs (Aimovig/Emgality) OR Botox",
          "step2Req": "Documented failure/intolerance",
          "step2Duration": "J3032; Non-Preferred; Site of Care restriction - non-hospital settings preferred unless medical necessity (severe infusion reaction history",
          "quantityLimit": " difficult venous access)",
          "contraBypass": "Yes - inability to self-inject; GI malabsorption (bioavailability argument); SC injection failures",
          "goldCardAvail": "N/A - Medicaid MCO",
          "goldCardThresh": null,
          "policyId": "Centene CP.FC.05 Vyepti",
          "sourceDoc": "New_York_2026_PA_Audit",
          "denialCode": "DENY-QL-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Gepants (Preventive)": {
          "state": "NY",
          "payerName": "Fidelis",
          "payerType": "Medicaid MCO",
          "lob": "Medicaid",
          "drugClass": "Gepants (Preventive)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "Submit to NYRx not Fidelis",
          "step1Duration": null,
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "30 tabs/30 days",
          "contraBypass": null,
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": null,
          "sourceDoc": "New_York_2026_PA_Audit.docx",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "Split benefit trap - pharmacy carved to NYRx"
        }
      },
      "NY-COM-EMPIREBCBS": {
        "Gepants (Acute)": {
          "state": "NY",
          "payerName": "Empire BlueCross BlueShield",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 different triptans (sumatriptan, rizatriptan, etc.),≥4 weeks each,N/A",
          "step1Duration": null,
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Qulipta/Nurtec Tier 2 (oral-forward formulary); Ubrelvy Tier 3/4; standard QL enforcement",
          "contraBypass": "Yes - CV risk factors (CAD, PVD, uncontrolled HTN) = triptan contraindicated = immediate bypass per NY Ins Law §4903",
          "goldCardAvail": "Pending (S7470)",
          "goldCardThresh": "N/A - pending legislation",
          "policyId": "Empire Select Drug List 2026",
          "sourceDoc": "New_York_2026_PA_Audit",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "CGRP mAbs (SC)": {
          "state": "NY",
          "payerName": "Empire BlueCross BlueShield",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥1-2 oral preventive classes (Beta-blockers, Anticonvulsants) - plan rider dependent; CAPPED at 2 per NY law",
          "step1Duration": "≤30 days or per guidelines",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Qulipta/Nurtec/Emgality/Aimovig Tier 2 PREFERRED; Ajovy Tier 3/4 Non-Preferred; Empire is 'oral-forward' - favorable for patients preferring oral over injection",
          "contraBypass": "Yes - asthma/bradycardia (beta-blocker contraindication); cognitive impairment (topiramate); teratogenic bypass",
          "goldCardAvail": "Pending (S7470)",
          "goldCardThresh": "N/A - pending legislation",
          "policyId": "Empire CGRP Policy",
          "sourceDoc": "New_York_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Neurotoxins": {
          "state": "NY",
          "payerName": "Empire BlueCross BlueShield",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes - CAPPED at 2 per NY Chapter 20",
          "step1Duration": "≥2 months each (≤30 days if adverse event)",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Chronic Migraine (≥15 HA days/mo); Medical Benefit; adheres to NGS LCD L33646 for Medicare Advantage",
          "contraBypass": "Yes - documented adverse events; stability on current therapy per NY Ins Law §4903(c-1)",
          "goldCardAvail": "Pending (S7470)",
          "goldCardThresh": "N/A - pending legislation",
          "policyId": "Empire Medical Policy Botox",
          "sourceDoc": "New_York_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        },
        "CGRP mAbs (IV)": {
          "state": "NY",
          "payerName": "Empire BlueCross BlueShield",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (IV)",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "≥2 months each",
          "step2Req": "Failure of SC CGRPs preferred",
          "step2Duration": "Documented",
          "quantityLimit": "Non-Preferred Tier 3/4; Medical Benefit",
          "contraBypass": "Yes - inability to self-inject; dexterity issues; cognitive impairment",
          "goldCardAvail": "Pending (S7470)",
          "goldCardThresh": "N/A - pending legislation",
          "policyId": "Empire Vyepti Policy",
          "sourceDoc": "New_York_2026_PA_Audit",
          "denialCode": "DENY-QL-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "NY-MA-EMPIREBCBS": {
        "Neurotoxins": {
          "state": "NY",
          "payerName": "Empire BCBS",
          "payerType": "Medicare Advantage",
          "lob": "Part B",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "Per NGS LCD L33646",
          "step1Duration": "Adequate trial",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "155 units/12 weeks",
          "contraBypass": "Yes",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "LCD L33646",
          "sourceDoc": "New_York_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        }
      },
      "NY-COM-UHC": {
        "Gepants (Acute)": {
          "state": "NY",
          "payerName": "UnitedHealthcare (Oxford)",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 triptans (failure/contraindication/intolerance)",
          "step1Duration": "≥4 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Nurtec ODT 8 tabs/30d acute (15-16 tabs if approved for prevention); Ubrelvy 10-16 tabs/30d; aggressive QL enforcement; MOH monitoring",
          "contraBypass": "Yes - CV contraindication; reauth requires NO medication overuse headache + clinical improvement documented",
          "goldCardAvail": "Yes (Voluntary)",
          "goldCardThresh": "92% approval rate on specific codes - check UHC Provider Portal for eligibility",
          "policyId": "UHC PA-Notification-Nurtec-Qulipta-Ubrelvy-Zavzpret",
          "sourceDoc": "New_York_2026_PA_Audit",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "CGRP mAbs (SC)": {
          "state": "NY",
          "payerName": "UnitedHealthcare (Oxford)",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes - strict step therapy enforcement via Designated Specialty Programs",
          "step1Duration": "≥8 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Aimovig/Emgality PREFERRED; Ajovy EXCLUDED or Non-Preferred (must fail preferred first); Qulipta/Nurtec gated behind oral preventive failures",
          "contraBypass": "Yes - teratogenic; CV contraindication; documented intolerance",
          "goldCardAvail": "Yes (Voluntary)",
          "goldCardThresh": "92% approval rate on specific codes",
          "policyId": "UHC PA-CGRP-Receptor-Antagonists",
          "sourceDoc": "New_York_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Neurotoxins": {
          "state": "NY",
          "payerName": "UnitedHealthcare (Oxford)",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥3 oral preventive classes (Antidepressants, Anticonvulsants, Beta-blockers) - ⚠️ POTENTIALLY NON-COMPLIANT with NY 2-drug cap law",
          "step1Duration": "≥8 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Chronic Migraine (≥15 HA days/mo for >3 months); 50% REDUCTION in frequency/intensity required for reauth - higher bar than 'clinical improvement'; precise documentation required",
          "contraBypass": "Yes - documented specific failures; APPEAL 3rd drug requirement citing NY Chapter 20 Laws 2025 (N.Y. Ins. Law §4902)",
          "goldCardAvail": "Yes (Voluntary)",
          "goldCardThresh": "92% approval rate on specific codes",
          "policyId": "UHC Policy 2026T0004W",
          "sourceDoc": "New_York_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        },
        "CGRP mAbs (IV)": {
          "state": "NY",
          "payerName": "UnitedHealthcare (Oxford)",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (IV)",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "≥8 weeks each",
          "step2Req": "≥2 SC CGRPs (Aimovig/Emgality)",
          "step2Duration": "Documented failure/intolerance",
          "quantityLimit": "Non-Preferred; Medical Benefit; site of care management",
          "contraBypass": "Yes - inability to self-inject; SC intolerance; bioavailability argument for GI issues",
          "goldCardAvail": "Yes (Voluntary)",
          "goldCardThresh": "92% approval rate",
          "policyId": "UHC Vyepti Policy",
          "sourceDoc": "New_York_2026_PA_Audit",
          "denialCode": "DENY-STEP-005",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Gepants (Preventive)": {
          "state": "NY",
          "payerName": "UHC NY",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Preventive)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "Fail triptans (acute history) AND oral preventives",
          "step1Duration": "≥8 weeks",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "30 tabs/30 days",
          "contraBypass": "Yes - standard",
          "goldCardAvail": "No",
          "goldCardThresh": null,
          "policyId": null,
          "sourceDoc": "New_York_2026_PA_Audit.docx",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "Strictly gated - triptan AND oral preventive failures"
        }
      },
      "NY-COM-EMBLEM": {
        "Neurotoxins": {
          "state": "NY",
          "payerName": "EmblemHealth (GHI/HIP)",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "≥8 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Always requires Preauthorization; Medical Benefit; clinical improvement for reauth; emphasize 'impact on essential job functions' for City employees",
          "contraBypass": "Yes - documented oral preventive failures/intolerances",
          "goldCardAvail": "Pending (S7470)",
          "goldCardThresh": "N/A - pending legislation",
          "policyId": "EmblemHealth Medical Policy",
          "sourceDoc": "New_York_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        },
        "Gepants (Acute)": {
          "state": "NY",
          "payerName": "EmblemHealth (GHI/HIP)",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 triptans",
          "step1Duration": "≥4 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "All CGRPs (oral and injectable) require Preauthorization; Express Scripts PBM",
          "contraBypass": "Yes - CV contraindication",
          "goldCardAvail": "Pending (S7470)",
          "goldCardThresh": "N/A - pending legislation",
          "policyId": "EmblemHealth 2026 Preauth List",
          "sourceDoc": "New_York_2026_PA_Audit",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "CGRP mAbs (SC)": {
          "state": "NY",
          "payerName": "EmblemHealth (GHI/HIP)",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes - CAPPED at 2 per NY law,≥8 weeks each,N/A",
          "step1Duration": null,
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Aimovig/Emgality PREFERRED; transitioning to NYCE PPO (UHC partnership) eff 1/1/2026 - may align with stricter UHC guidelines; City employee population - emphasize 'Occupational Impact' in appeals",
          "contraBypass": "Yes - functional impairment affecting essential job functions (police, fire, teachers); contraindications",
          "goldCardAvail": "Pending (S7470)",
          "goldCardThresh": "N/A - pending legislation",
          "policyId": "EmblemHealth CGRP Policy",
          "sourceDoc": "New_York_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "CGRP mAbs (IV)": {
          "state": "NY",
          "payerName": "EmblemHealth (GHI/HIP)",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (IV)",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes,≥8 weeks each",
          "step1Duration": "Failed self-injectables",
          "step2Req": "Documented failure/intolerance",
          "step2Duration": "Non-Preferred; restricted to patients who failed SC or have medical reason preventing self-injection (dexterity",
          "quantityLimit": " cognitive impairment)",
          "contraBypass": "Yes - inability to self-inject; documented SC failures",
          "goldCardAvail": "Pending (S7470)",
          "goldCardThresh": "N/A - pending legislation",
          "policyId": "EmblemHealth Vyepti Policy",
          "sourceDoc": "New_York_2026_PA_Audit",
          "denialCode": "DENY-QL-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "NY-MAC-NGS": {
        "Neurotoxins": {
          "state": "NY",
          "payerName": "National Government Services",
          "payerType": "Medicare MAC",
          "lob": "Part B",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 conventional preventives; ≥15 days/month x 3 months",
          "step1Duration": "Adequate trial",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "155 units/12 weeks; 12-week interval strict",
          "contraBypass": "Yes",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "LCD L33646",
          "sourceDoc": "Q1-2026-Policy-Refresh",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "Managed under LCD L39832; strictly enforces >15 headache days/month threshold"
        }
      },
      "FL-COM-FLBLUECOM": {
        "CGRP mAbs (SC)": {
          "state": "FL",
          "payerName": "Florida Blue",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥1 standard oral preventive class (Beta-blockers: propranolol, Anticonvulsants: topiramate, Antidepressants: amitriptyline)",
          "step1Duration": "≥8-12 weeks",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Aimovig/Emgality PREFERRED; Ajovy requires step through preferred (unless latex allergy); ValueScript CLOSED formulary - non-listed drugs require Formulary Exception",
          "contraBypass": "Yes - intolerance; contraindication; latex allergy for autoinjector devices",
          "goldCardAvail": "Yes (SB 7016)",
          "goldCardThresh": ">90% approval in 2025",
          "policyId": "Policy 05-70-068",
          "sourceDoc": "Florida_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Gepants (Acute)": {
          "state": "FL",
          "payerName": "Florida Blue",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "\"≥2 triptans (sumatriptan, rizatriptan, eletriptan)\",Failure = lack of efficacy after treating ≥3 attacks OR intolerance/contraindication",
          "step1Duration": null,
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Standard QL; Tier 3/4; Zavzpret NON-PREFERRED",
          "contraBypass": "Yes - CV risk factors (CAD, uncontrolled HTN) = 'Contraindication to vasoconstrictive agents' bypasses triptan step entirely",
          "goldCardAvail": "Yes (SB 7016)",
          "goldCardThresh": ">90% approval in 2025",
          "policyId": "Florida Blue Acute Migraine Policy",
          "sourceDoc": "Florida_2026_PA_Audit",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "CGRP mAbs (IV)": {
          "state": "FL",
          "payerName": "Florida Blue",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (IV)",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "≥8 weeks each",
          "step2Req": "PA Required",
          "step2Duration": "Documented",
          "quantityLimit": "Medical Benefit (J3032); PA Required",
          "contraBypass": "Yes - inability to self-inject; documented SC failures",
          "goldCardAvail": "Yes (SB 7016)",
          "goldCardThresh": ">90% approval in 2025",
          "policyId": "Florida Blue Medical Benefit",
          "sourceDoc": "Q1-2026-Policy-Refresh",
          "denialCode": "DENY-GOLD-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "Initiation criteria explicitly requires at least 15 headache days per month of migraine-like or tension-like headache for a minimum of 3 months (chronic migraine) AND at least 8 migraine headache days per month for a minimum of 3 months, OR the agent must be FDA approved for the specific migraine pr"
        }
      },
      "FL-COM-UHC": {
        "CGRP mAbs (SC)": {
          "state": "FL",
          "payerName": "UnitedHealthcare of Florida",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes,≥8 weeks each",
          "step1Duration": null,
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Aimovig/Emgality PREFERRED on Advantage formulary; Vyepti requires Part B Step Therapy (fail SC CGRP first) for MA patients",
          "contraBypass": "Yes - teratogenic; CV contraindication; physical barrier to self-injection (severe arthritis, cognitive impairment)",
          "goldCardAvail": "Yes (SB 7016)",
          "goldCardThresh": "Internal Gold Card + FL state mandate",
          "policyId": "UHC CGRP Policy",
          "sourceDoc": "Florida_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Gepants (Acute)": {
          "state": "FL",
          "payerName": "UnitedHealthcare of Florida",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 triptan failures - strict enforcement",
          "step1Duration": "≥4 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Nurtec 16 tabs/30d (even for acute); Ubrelvy 10-16 tabs/30d; strict QL; to exceed QL cite 'Minimal rebound headache risk with gepants compared to triptans/opioids'",
          "contraBypass": "Yes - CV contraindication",
          "goldCardAvail": "Yes (SB 7016)",
          "goldCardThresh": "Internal Gold Card + FL state mandate",
          "policyId": "UHC Acute Gepant Policy",
          "sourceDoc": "Florida_2026_PA_Audit",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Neurotoxins": {
          "state": "FL",
          "payerName": "UnitedHealthcare of Florida",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "≥8 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Botox PREFERRED for migraine; must verify frequency via headache diary/log; HIT-6 scores required for functional impairment; Daxxify EXCLUDED (requires failure of all other toxins first)",
          "contraBypass": "Yes - documented failures with HIT-6 documentation",
          "goldCardAvail": "Yes (SB 7016)",
          "goldCardThresh": "Internal Gold Card + FL state mandate",
          "policyId": "UHC Botulinum Toxins A and B",
          "sourceDoc": "Florida_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        },
        "CGRP mAbs (IV)": {
          "state": "FL",
          "payerName": "UnitedHealthcare of Florida",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (IV)",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "≥8 weeks each",
          "step2Req": "Part B Step Therapy: Fail Aimovig OR Ajovy OR Emgality first (for MA patients)",
          "step2Duration": "Documented failure/intolerance",
          "quantityLimit": "J3032; Part B Step Therapy REQUIRED for MA; LMN must state: 'Patient has failed SC CGRP therapy due to [specific reason]'",
          "contraBypass": "Yes - injection site reaction; lack of SC efficacy; inability to self-inject",
          "goldCardAvail": "Yes (SB 7016)",
          "goldCardThresh": "Internal Gold Card + FL state mandate",
          "policyId": "UHC Part B Step Therapy Policy",
          "sourceDoc": "Florida_2026_PA_Audit",
          "denialCode": "DENY-GOLD-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "FL-MCD-SUNSHINE": {
        "CGRP mAbs (SC)": {
          "state": "FL",
          "payerName": "Sunshine Health",
          "payerType": "Medicaid MCO",
          "lob": "Medicaid",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 different oral preventive classes (Beta-blocker AND Anticonvulsant) - stricter than commercial 1-class requirement",
          "step1Duration": "≥8 weeks each; adherence verified via claims refill history",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Aimovig/Emgality historically preferred; Ajovy requires PA; bound by AHCA PDL (quarterly updates)",
          "contraBypass": "Yes - documented intolerances; contraindications; EPSDT override for pediatric (must use phrase 'Medically necessary under EPSDT guidelines')",
          "goldCardAvail": "Yes (SB 7016)",
          "goldCardThresh": "Statutorily required for Medicaid",
          "policyId": "AHCA PDL / Sunshine Clinical PA",
          "sourceDoc": "Florida_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Gepants (Acute)": {
          "state": "FL",
          "payerName": "Sunshine Health",
          "payerType": "Medicaid MCO",
          "lob": "Medicaid",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 triptans (Generic: Rizatriptan, Sumatriptan) - brand triptans (Imitrex) EXCLUDED",
          "step1Duration": "≥4 weeks each; adherence verified via claims history",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Nurtec ODT generally preferred over Ubrelvy/Qulipta (rebate status fluctuates); Zavzpret/Trudhesa/Tosymra NON-PREFERRED",
          "contraBypass": "Yes - CV contraindication; prescribing brand without documented generic trial = automatic POS rejection",
          "goldCardAvail": "Yes (SB 7016)",
          "goldCardThresh": "Statutorily required for Medicaid",
          "policyId": "AHCA PDL 2026",
          "sourceDoc": "Florida_2026_PA_Audit",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Neurotoxins": {
          "state": "FL",
          "payerName": "Sunshine Health",
          "payerType": "Medicaid MCO",
          "lob": "Medicaid",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "≥8 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Chronic Migraine diagnosis; specific 'Botulinum Criteria' form required - must list specific muscles to inject + total dosage",
          "contraBypass": "Yes - oral preventive contraindications/intolerances",
          "goldCardAvail": "Yes (SB 7016)",
          "goldCardThresh": "Statutorily required for Medicaid",
          "policyId": "Sunshine Botulinum Criteria Form",
          "sourceDoc": "Florida_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        },
        "CGRP mAbs (IV)": {
          "state": "FL",
          "payerName": "Sunshine Health",
          "payerType": "Medicaid MCO",
          "lob": "Medicaid",
          "drugClass": "CGRP mAbs (IV)",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "≥8 weeks each",
          "step2Req": "Medical PA Required",
          "step2Duration": "Documented",
          "quantityLimit": "Medical PA Required; J3032",
          "contraBypass": "Yes - inability to self-inject; documented SC failures",
          "goldCardAvail": "Yes (SB 7016)",
          "goldCardThresh": "Statutorily required for Medicaid",
          "policyId": "Sunshine Medical PA",
          "sourceDoc": "Florida_2026_PA_Audit",
          "denialCode": "DENY-GOLD-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "FL-COM-AETNA": {
        "Neurotoxins": {
          "state": "FL",
          "payerName": "Aetna Florida",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "⚠️ ≥3 oral preventive classes (OR 2 orals + 1 CGRP) - STRICTER than FL Blue/Sunshine 2-class requirement",
          "step1Duration": "≥8 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Chronic Migraine; restrictive dual therapy (Botox+CGRP) - must prove 'synergy' with phrase: 'Treatment-refractory chronic migraine requiring synergistic dual therapy'",
          "contraBypass": "Yes - document 3 distinct oral failures (e.g.,Propranolol + Topiramate + Amitriptyline)",
          "goldCardAvail": "Yes (SB 7016)",
          "goldCardThresh": "Active",
          "policyId": "Aetna Botox Policy",
          "sourceDoc": "Florida_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        },
        "Gepants (Acute)": {
          "state": "FL",
          "payerName": "Aetna Florida",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 triptans",
          "step1Duration": "≥4 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Standard QL; Policy 3481-E",
          "contraBypass": "Yes - CV contraindication",
          "goldCardAvail": "Yes (SB 7016)",
          "goldCardThresh": "Active",
          "policyId": "Aetna Policy 3481-E",
          "sourceDoc": "Florida_2026_PA_Audit",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "CGRP mAbs (SC)": {
          "state": "FL",
          "payerName": "Aetna Florida",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 standard oral preventive classes (Beta-blocker AND Topiramate)",
          "step1Duration": "≥8 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Aimovig/Ajovy typically PREFERRED; Emgality may be EXCLUDED on some plans (requires Medical Necessity appeal); Qulipta requires step through injectable CGRP first",
          "contraBypass": "Yes - intolerance; contraindication; teratogenic bypass",
          "goldCardAvail": "Yes (SB 7016)",
          "goldCardThresh": "Active",
          "policyId": "Aetna CGRP Policy",
          "sourceDoc": "Florida_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "CGRP mAbs (IV)": {
          "state": "FL",
          "payerName": "Aetna Florida",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (IV)",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "≥8 weeks each",
          "step2Req": "Medical PA Required",
          "step2Duration": "Documented",
          "quantityLimit": "Medical PA Required; J3032",
          "contraBypass": "Yes - inability to self-inject; SC failures",
          "goldCardAvail": "Yes (SB 7016)",
          "goldCardThresh": "Active",
          "policyId": "Aetna Medical Benefit",
          "sourceDoc": "Florida_2026_PA_Audit",
          "denialCode": "DENY-GOLD-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "FL-MAC-FCSO": {
        "Neurotoxins": {
          "state": "FL",
          "payerName": "First Coast Service Options",
          "payerType": "Medicare MAC",
          "lob": "Part B",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "Per LCD; ASC PA demonstration expansion",
          "step1Duration": "Adequate trial",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "155 units/12 weeks",
          "contraBypass": "Yes",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "FCSO LCD",
          "sourceDoc": "Q1-2026-Policy-Refresh",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "Updated Botulinum Toxin LCD requiring aggressive documentation and peer-reviewed literature for dosages exceeding FDA-labeled maximums per affected muscle, strict exclusion of cosmetic utilization, and mandatory ABN/GA modifier usage for claim protection."
        }
      },
      "NC-COM-NCARBCBS": {
        "CGRP mAbs (SC)": {
          "state": "NC",
          "payerName": "Blue Cross Blue Shield of North Carolina",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes (Beta-blockers, TCAs, Anticonvulsants)",
          "step1Duration": "≥8 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "PREFERRED (Tier 3): Aimovig, Emgality; NON-PREFERRED/RESTRICTED: Ajovy (especially on Essential formulary), Vyepti; requests for non-preferred require failure/intolerance to preferred documented; 'Net Results' formulary uses aggressive 'Value PA' steering to generics",
          "contraBypass": "Yes - teratogenic; CV contraindication; documented intolerance",
          "goldCardAvail": "HB 434 - pending",
          "goldCardThresh": "80% threshold",
          "policyId": "BCBS NC CGRP Policy",
          "sourceDoc": "North_Carolina_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Gepants (Acute)": {
          "state": "NC",
          "payerName": "Blue Cross Blue Shield of North Carolina",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 triptans",
          "step1Duration": "Documented failure",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Ubrelvy Tier 3; Nurtec ODT Tier 3; QL strictly enforced 16 tabs/30d - exceptions difficult without proving not a candidate for preventive therapy",
          "contraBypass": "Yes - CV contraindication (CAD/HTN)",
          "goldCardAvail": "HB 434 - pending; submit data Q1 2026",
          "goldCardThresh": "80% threshold",
          "policyId": "BCBS NC Formulary",
          "sourceDoc": "North_Carolina_2026_PA_Audit",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Neurotoxins": {
          "state": "NC",
          "payerName": "Blue Cross Blue Shield of North Carolina",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes (less restrictive than Medicaid 3-class)",
          "step1Duration": "≥8 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Chronic Migraine (≥15 days/mo); Carelon may manage; dual therapy (Botox+CGRP) RESTRICTED but allows 'Medical Necessity' exception for refractory chronic migraine eff Jan 1 2026 - must submit headache logs showing partial response to monotherapy + synergistic mechanism rationale",
          "contraBypass": "Yes - oral preventive contraindications; dual therapy requires refractory documentation",
          "goldCardAvail": "HB 434 - pending",
          "goldCardThresh": "80% threshold for CPT 64615",
          "policyId": "BCBS NC Medical Policy",
          "sourceDoc": "North_Carolina_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        },
        "CGRP mAbs (IV)": {
          "state": "NC",
          "payerName": "Blue Cross Blue Shield of North Carolina",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (IV)",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "≥8 weeks each",
          "step2Req": "Medical Necessity documentation",
          "step2Duration": "Documented",
          "quantityLimit": "NON-PREFERRED; requires medical necessity for infusion setting",
          "contraBypass": "Yes - needle phobia; inability to self-inject",
          "goldCardAvail": "HB 434 - pending",
          "goldCardThresh": "80% threshold",
          "policyId": "BCBS NC Medical Policy",
          "sourceDoc": "North_Carolina_2026_PA_Audit",
          "denialCode": "DENY-QL-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "NC-COM-UHC": {
        "CGRP mAbs (SC)": {
          "state": "NC",
          "payerName": "UnitedHealthcare North Carolina",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes (beta-blockers, anticonvulsants, antidepressants)",
          "step1Duration": "≥8 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "PREFERRED: Aimovig, Emgality; ⚠️ Vyepti = STEP 3 agent: requires failure of 2 OTHER CGRP mAbs (e.g., Aimovig AND Emgality) before approval - higher hurdle than Medicaid",
          "contraBypass": "Yes - teratogenic; CV contraindication; documented intolerance",
          "goldCardAvail": "ACTIVE Gold Card",
          "goldCardThresh": "92% threshold",
          "policyId": "UHC CGRP Policy",
          "sourceDoc": "North_Carolina_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Neurotoxins": {
          "state": "NC",
          "payerName": "UnitedHealthcare North Carolina",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "⚠️ ≥3 prophylactic classes (aligned with Medicaid, STRICTER than BCBS 2-class)",
          "step1Duration": "≥8 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Medical Benefit Drug Policy 2026D0017AN eff Jan 1 2026; Chronic Migraine (≥15 days/mo); Botox = preferred neurotoxin (Dysport/Xeomin/Myobloc off-label/unproven for migraine = generally denied)",
          "contraBypass": "Yes - oral preventive contraindications",
          "goldCardAvail": "ACTIVE Gold Card",
          "goldCardThresh": "92% threshold for CPT 64615",
          "policyId": "UHC Policy 2026D0017AN",
          "sourceDoc": "North_Carolina_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        },
        "Gepants (Acute)": {
          "state": "NC",
          "payerName": "UnitedHealthcare North Carolina",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 triptans",
          "step1Duration": "Documented failure/intolerance",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Nurtec/Ubrelvy standard criteria; Zavzpret highly restricted",
          "contraBypass": "Yes - CV contraindication",
          "goldCardAvail": "ACTIVE Gold Card",
          "goldCardThresh": "92% on ≥10 PAs for 2 years",
          "policyId": "UHC PA-Notification Policy",
          "sourceDoc": "North_Carolina_2026_PA_Audit",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Gepants (Preventive)": {
          "state": "NC",
          "payerName": "UnitedHealthcare North Carolina",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Preventive)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral prophylactic classes",
          "step1Duration": "≥8 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "⚠️ EXCLUSION: Concurrent use of Qulipta with Aimovig/Emgality BLOCKED by edit logic - appeals for dual therapy must cite 'refractory' status + distinct mechanisms",
          "contraBypass": "Yes - documented intolerance; contraindication",
          "goldCardAvail": "ACTIVE Gold Card",
          "goldCardThresh": "92% threshold",
          "policyId": "UHC Qulipta Policy",
          "sourceDoc": "North_Carolina_2026_PA_Audit",
          "denialCode": "DENY-STEP-005",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "CGRP mAbs (IV)": {
          "state": "NC",
          "payerName": "UnitedHealthcare North Carolina",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (IV)",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "≥8 weeks each",
          "step2Req": "Must fail 2 other CGRP mAbs (Step 3)",
          "step2Duration": "Documented failure of Aimovig AND Emgality (or similar)",
          "quantityLimit": "J3032; Step 3 agent - highest hurdle for Vyepti among commercial payers",
          "contraBypass": "Yes - needle phobia; inability to self-inject; documented absorption failure",
          "goldCardAvail": "ACTIVE Gold Card",
          "goldCardThresh": "92% threshold on J3032",
          "policyId": "UHC Vyepti Policy",
          "sourceDoc": "North_Carolina_2026_PA_Audit",
          "denialCode": "DENY-QL-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "CT-COM-ELEV": {
        "CGRP mAbs (SC)": {
          "state": "CT",
          "payerName": "Anthem BCBS CT",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "≥8 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Monthly supply",
          "contraBypass": "Yes",
          "goldCardAvail": "No state mandate",
          "goldCardThresh": null,
          "policyId": "CarelonRx Policy",
          "sourceDoc": "Connecticut_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": "8.0",
          "episodicNotes": "Anthem: Episodic (<8d) = 1 oral class; Episodic (≥8d) = same as chronic (1 oral class). More lenient than most payers for episodic."
        }
      },
      "CT-COM-CTCARE": {
        "Gepants (Acute)": {
          "state": "CT",
          "payerName": "ConnectiCare/Molina",
          "payerType": "Exchange",
          "lob": "Exchange",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 triptans",
          "step1Duration": "Trial required",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Nurtec 8/30d, Ubrelvy 16/30d",
          "contraBypass": "Yes - CV contraindication",
          "goldCardAvail": "No",
          "goldCardThresh": null,
          "policyId": "Molina Policy",
          "sourceDoc": "Connecticut_2026_PA_Audit",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "CGRP mAbs (SC)": {
          "state": "CT",
          "payerName": "ConnectiCare/Molina",
          "payerType": "Exchange",
          "lob": "Exchange",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes; Ajovy/Emgality/Qulipta/Nurtec preferred",
          "step1Duration": "≥2 months each",
          "step2Req": "Aimovig Non-Preferred (fail 2 preferred)",
          "step2Duration": null,
          "quantityLimit": "Monthly supply",
          "contraBypass": "Yes; Dual Therapy clause for refractory",
          "goldCardAvail": "No",
          "goldCardThresh": null,
          "policyId": "Molina Policy 17/18",
          "sourceDoc": "Connecticut_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "TX-COM-BCBSTX": {
        "Gepants (Acute)": {
          "state": "TX",
          "payerName": "Blue Cross Blue Shield of Texas",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 triptans from Balanced Drug List,≥4 weeks each,N/A",
          "step1Duration": null,
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Ubrelvy 16/30d, Nurtec 8/30d (Tier 3 PA/QL)",
          "contraBypass": "Yes - CV contraindication (ischemic heart disease, uncontrolled HTN, cerebrovascular disease)",
          "goldCardAvail": "Yes (HB 3459/HB 3812)",
          "goldCardThresh": "90% approval on 5+ requests; annual evaluation",
          "policyId": "Balanced Drug List 2026",
          "sourceDoc": "Texas_2026_PA_Audit",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "CGRP mAbs (SC)": {
          "state": "TX",
          "payerName": "Blue Cross Blue Shield of Texas",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "\"≥2 oral preventive classes (Beta-blocker, Anticonvulsant, TCA, SNRI)\",≥3 months each (stricter than UHC 2-month)",
          "step1Duration": null,
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Monthly supply; Aimovig/Emgality preferred; Ajovy steeper hurdles",
          "contraBypass": "Yes - adverse events (cognitive slowing/paresthesia for topiramate, hypotension/bradycardia for beta-blockers); teratogenic bypass",
          "goldCardAvail": "Yes (HB 3459/HB 3812)",
          "goldCardThresh": "90% approval on 5+ requests; annual evaluation",
          "policyId": "Prime Therapeutics ST Policy",
          "sourceDoc": "Texas_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Neurotoxins": {
          "state": "TX",
          "payerName": "Blue Cross Blue Shield of Texas",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes,≥3 months each",
          "step1Duration": null,
          "step2Req": null,
          "step2Duration": "155-200 units/12 weeks; Chronic Migraine only (15+ days/mo",
          "quantityLimit": " 8+ migraine days)",
          "contraBypass": "Yes - oral preventive contraindications; dual therapy requires partial response documentation (30% reduction) + additional benefit (>50%)",
          "goldCardAvail": "Yes (HB 3459/HB 3812)",
          "goldCardThresh": "90% approval on 5+ requests",
          "policyId": "Medical Policy I-200-005",
          "sourceDoc": "Texas_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        },
        "CGRP mAbs (IV)": {
          "state": "TX",
          "payerName": "Blue Cross Blue Shield of Texas",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (IV)",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "≥3 months each",
          "step2Req": "≥2 sub-Q CGRPs (Aimovig/Emgality)",
          "step2Duration": "Documented failure/intolerance",
          "quantityLimit": "Per J3032 billing; Medical Benefit",
          "contraBypass": "Yes - inability to self-inject; SC CGRP failures",
          "goldCardAvail": "Yes (HB 3459/HB 3812)",
          "goldCardThresh": "90% approval rate",
          "policyId": "Medical Benefit Policy",
          "sourceDoc": "Texas_2026_PA_Audit",
          "denialCode": "DENY-GOLD-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "TX-COM-UHC": {
        "Gepants (Acute)": {
          "state": "TX",
          "payerName": "UnitedHealthcare",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 triptans (sumatriptan, rizatriptan, naratriptan) - 180-day pharmacy claims lookback",
          "step1Duration": "≥4 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Tier 2/3; strict QL enforcement; SmartPA auto-denial if no triptan claims history",
          "contraBypass": "Yes - CV contraindication; new-to-plan patients must manually document prior triptan use",
          "goldCardAvail": "Yes (HB 3459/HB 3812)",
          "goldCardThresh": "Annual evaluation Jan-Dec",
          "policyId": "OptumRx Step Therapy Migraine",
          "sourceDoc": "Texas_2026_PA_Audit",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "CGRP mAbs (SC)": {
          "state": "TX",
          "payerName": "UnitedHealthcare",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral prophylactic classes",
          "step1Duration": "≥2 months each (shorter than BCBSTX 3-month)",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Aimovig/Emgality Tier 2 Preferred; Ajovy excluded or Step 2 (fail preferred first)",
          "contraBypass": "Yes - injection site reaction; lack of efficacy on preferred agents",
          "goldCardAvail": "Yes (HB 3459/HB 3812)",
          "goldCardThresh": "Annual evaluation Jan-Dec",
          "policyId": "OptumRx CGRP Policy",
          "sourceDoc": "Texas_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Neurotoxins": {
          "state": "TX",
          "payerName": "UnitedHealthcare",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥3 oral preventive classes (Antidepressant, Antiepileptic, Beta-blocker) - MORE STRINGENT",
          "step1Duration": "≥8 weeks each; must specify drug/dose/duration in chart notes",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "200 units max/12 weeks; vague notes like 'tried oral meds' insufficient",
          "contraBypass": "Yes - documented specific failures with drug/dose/duration",
          "goldCardAvail": "Yes (HB 3459/HB 3812)",
          "goldCardThresh": "Annual evaluation Jan-Dec",
          "policyId": "UHC Medical Policy Botox",
          "sourceDoc": "Texas_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        },
        "CGRP mAbs (IV)": {
          "state": "TX",
          "payerName": "UnitedHealthcare",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (IV)",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "≥2 months each",
          "step2Req": "Demonstrate intolerance/failure of SC options",
          "step2Duration": "Documented",
          "quantityLimit": "Medical Benefit PA required",
          "contraBypass": "Yes - inability to self-inject; SC intolerance",
          "goldCardAvail": "Yes (HB 3459/HB 3812)",
          "goldCardThresh": "Annual evaluation Jan-Dec",
          "policyId": "UHC Medical Benefit",
          "sourceDoc": "Texas_2026_PA_Audit",
          "denialCode": "DENY-STEP-005",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "TX-MCD-SUPERIOR": {
        "Gepants (Acute)": {
          "state": "TX",
          "payerName": "Superior HealthPlan",
          "payerType": "Medicaid MCO",
          "lob": "Medicaid",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 preferred triptans per Texas VDP",
          "step1Duration": "≥4 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "9 tabs/month max; >9 requires MOH exclusion documentation",
          "contraBypass": "Yes - CV contraindication; MOH evaluation required for QL override",
          "goldCardAvail": "No (Medicaid excluded HB 3459)",
          "goldCardThresh": null,
          "policyId": "Superior Clinical Edit Triptans",
          "sourceDoc": "Texas_2026_PA_Audit",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "CGRP mAbs (SC)": {
          "state": "TX",
          "payerName": "Superior HealthPlan",
          "payerType": "Medicaid MCO",
          "lob": "Medicaid",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes per VDP criteria",
          "step1Duration": "≥8 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Non-Preferred on PDL; Clinical PA required proving standard treatment failure",
          "contraBypass": "Yes - teratogenic bypass; CV contraindication",
          "goldCardAvail": "No (Medicaid excluded HB 3459)",
          "goldCardThresh": null,
          "policyId": "Superior Clinical PA CGRP",
          "sourceDoc": "Texas_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Neurotoxins": {
          "state": "TX",
          "payerName": "Superior HealthPlan",
          "payerType": "Medicaid MCO",
          "lob": "Medicaid",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "≥8 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Medical Benefit; Chronic Migraine diagnosis required",
          "contraBypass": "Yes - oral preventive contraindications",
          "goldCardAvail": "No (Medicaid excluded HB 3459)",
          "goldCardThresh": null,
          "policyId": "Superior Medical Benefit",
          "sourceDoc": "Texas_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        }
      },
      "TX-COM-CIGNA": {
        "Gepants (Acute)": {
          "state": "TX",
          "payerName": "Cigna Healthcare of Texas",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 triptans",
          "step1Duration": "≥4 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Tier 2/3; high scrutiny on quantity overrides; ESI formulary restrictions",
          "contraBypass": "Yes - CV contraindication",
          "goldCardAvail": "Yes (HB 3459/HB 3812)",
          "goldCardThresh": "Biannual notifications",
          "policyId": "ESI Migraine DQM Policy",
          "sourceDoc": "Texas_2026_PA_Audit",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "CGRP mAbs (SC)": {
          "state": "TX",
          "payerName": "Cigna Healthcare of Texas",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "≥3 months each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Emgality/Aimovig Tier 2 Preferred; most restrictive exclusion lists; rebate-driven",
          "contraBypass": "Yes - teratogenic; CV contraindication",
          "goldCardAvail": "Yes (HB 3459/HB 3812)",
          "goldCardThresh": "Biannual notifications",
          "policyId": "ESI CGRP PA Policy",
          "sourceDoc": "Texas_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": "8.0",
          "episodicNotes": "Cigna: Standard episodic (4-7d) = triptan failure only for acute; High-freq episodic (≥8d) = 1 oral class for CGRP; Chronic (≥15d) = 2 oral classes. MIDAS ≥11 required for all preventives."
        },
        "Neurotoxins": {
          "state": "TX",
          "payerName": "Cigna Healthcare of Texas",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "≥8 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Chronic Migraine only; Medical Benefit",
          "contraBypass": "Yes - documented oral failures",
          "goldCardAvail": "Yes (HB 3459/HB 3812)",
          "goldCardThresh": "Biannual notifications",
          "policyId": "Cigna Botox Policy ip_0637",
          "sourceDoc": "Texas_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        }
      },
      "TX-MAC-NOVITAS": {
        "Neurotoxins": {
          "state": "TX",
          "payerName": "Novitas Solutions",
          "payerType": "Medicare MAC",
          "lob": "Part B",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "Traditional preventive methods proven unsuccessful",
          "step1Duration": "Documented in medical record",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "155-200 units/12 weeks per LCD DL39909; J0585; Chronic Migraine (>15 days/mo, ≥8 migraine days); objective scales (MIDAS/HIT-6) required",
          "contraBypass": "Yes - documented in chart with specific ICD-10 (G43.709/G43.719)",
          "goldCardAvail": "No (Federal Medicare exempt)",
          "goldCardThresh": null,
          "policyId": "LCD DL39909",
          "sourceDoc": "Texas_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        }
      },
      "CA-MCD-MEDICALRX": {
        "Gepants (Acute)": {
          "state": "CA",
          "payerName": "Medi-Cal Rx",
          "payerType": "Medicaid FFS",
          "lob": "Medicaid Pharmacy",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 preferred triptans (Sumatriptan, Rizatriptan, Naratriptan) - Code I checks 180-day claims history",
          "step1Duration": "≥4 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Nurtec 8/30d acute; 16/30d preventive requires separate PA; Ubrelvy requires triptan history in Medi-Cal system; Reject Code 75 if no triptan claims",
          "contraBypass": "Yes - CV contraindication (vasoconstrictive agents unsafe); non-vasoconstrictive mechanism bypass",
          "goldCardAvail": "No (State Medicaid)",
          "goldCardThresh": null,
          "policyId": "Form 61-211 / CDL Code I",
          "sourceDoc": "California_2026_PA_Audit",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "CGRP mAbs (SC)": {
          "state": "CA",
          "payerName": "Medi-Cal Rx",
          "payerType": "Medicaid FFS",
          "lob": "Medicaid Pharmacy",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥1-2 oral preventive classes (Antiepileptics: Divalproex/Topiramate, Beta-blockers: Propranolol/Metoprolol, Antidepressants: Amitriptyline/Venlafaxine)",
          "step1Duration": "≥8 weeks each at therapeutic dose",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Code I PA Required; Chronic Migraine (≥15 HA days/mo) or Episodic (≥4 HA days/mo); Emgality has Labeler Restriction (Eli Lilly NDCs only); 2026 grandfathering reset",
          "contraBypass": "Yes - teratogenic bypass for females of childbearing potential (Valproate/Topiramate FDA Cat D/X); CGRP has favorable safety profile",
          "goldCardAvail": "No (State Medicaid)",
          "goldCardThresh": null,
          "policyId": "Form 61-211 / Medi-Cal Rx CDL",
          "sourceDoc": "California_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "CGRP mAbs (IV)": {
          "state": "CA",
          "payerName": "Medi-Cal Rx",
          "payerType": "Medicaid FFS",
          "lob": "Medicaid Pharmacy",
          "drugClass": "CGRP mAbs (IV)",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "≥8 weeks",
          "step2Req": "≥2 SC CGRPs (Aimovig/Emgality)",
          "step2Duration": "Documented failure/intolerance",
          "quantityLimit": "Non-Preferred with higher PA hurdles; Medical Benefit via MCP",
          "contraBypass": "Yes - inability to self-inject; SC CGRP intolerance",
          "goldCardAvail": "No (State Medicaid)",
          "goldCardThresh": null,
          "policyId": "Medi-Cal Rx CDL",
          "sourceDoc": "California_2026_PA_Audit",
          "denialCode": "DENY-STEP-005",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "CA-MCD-LACARE": {
        "Neurotoxins": {
          "state": "CA",
          "payerName": "L.A. Care Health Plan",
          "payerType": "Medicaid MCO",
          "lob": "Medical Benefit",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes (Beta-blockers, Anticonvulsants, TCAs)",
          "step1Duration": "≥8 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Medical Benefit (pharmacy carved to Medi-Cal Rx); Chronic Migraine (≥15 HA days/mo, ≥8 migraine days) for ≥3 months; Episodic NOT covered; IPA delegation creates variability",
          "contraBypass": "Yes - oral preventive contraindications; attach L.A. Care Clinical Policy to IPA submissions",
          "goldCardAvail": "No (Medicaid)",
          "goldCardThresh": null,
          "policyId": "L.A. Care Medical Policy",
          "sourceDoc": "California_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        }
      },
      "CA-COM-KAISER": {
        "CGRP mAbs (SC)": {
          "state": "CA",
          "payerName": "Kaiser Permanente",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥3 oral preventive classes (Beta-Blocker: Propranolol/Atenolol, TCA: Amitriptyline/Nortriptyline, Anticonvulsant: Topiramate/Divalproex) - MOST RESTRICTIVE",
          "step1Duration": "≥6-8 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Tier 4/Non-Preferred; CGRPs behind formidable wall of generic failures; Vyepti reserved as 'last resort' requiring SC CGRP failure first",
          "contraBypass": "Yes - significant functional impairment (MIDAS Grade IV); beta-blocker contraindicated due to asthma/bradycardia; TCA contraindicated due to sedation/arrhythmia risk; topiramate cognitive slowing/paresthesia",
          "goldCardAvail": "SB 306 Data Calibration 2026",
          "goldCardThresh": "Exemptions effective 2028",
          "policyId": "Kaiser CGRP PA Form",
          "sourceDoc": "California_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Gepants (Acute)": {
          "state": "CA",
          "payerName": "Kaiser Permanente",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 triptans from Kaiser formulary",
          "step1Duration": "≥4 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Tier 4/Non-Preferred; closed formulary; internal referral system",
          "contraBypass": "Yes - CV contraindication; vascular risk factors",
          "goldCardAvail": "SB 306 Data Calibration 2026",
          "goldCardThresh": "Exemptions effective 2028",
          "policyId": "Kaiser Internal Guidelines",
          "sourceDoc": "California_2026_PA_Audit",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Neurotoxins": {
          "state": "CA",
          "payerName": "Kaiser Permanente",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥3 oral preventive classes (most restrictive)",
          "step1Duration": "≥6-8 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Stopping Rule: 50% reduction required after 2 cycles (6 months) or therapy discontinued; must document baseline frequency (e.g., 20 days/mo) and current frequency; vague 'doing better' = denial",
          "contraBypass": "Yes - multiple documented intolerances; MIDAS Grade IV functional impairment",
          "goldCardAvail": "SB 306 Data Calibration 2026",
          "goldCardThresh": "Exemptions effective 2028",
          "policyId": "Kaiser Botox Policy clinical-review-botox",
          "sourceDoc": "California_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        },
        "CGRP mAbs (IV)": {
          "state": "CA",
          "payerName": "Kaiser Permanente",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (IV)",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥3 oral preventive classes",
          "step1Duration": "≥6-8 weeks each",
          "step2Req": "≥1 SC CGRP mAb (Aimovig/Ajovy/Emgality)",
          "step2Duration": "Documented failure/intolerance",
          "quantityLimit": "Last resort; requires oral + SC CGRP failures; Medical Benefit",
          "contraBypass": "Yes - inability to self-inject; documented SC failures",
          "goldCardAvail": "SB 306 Data Calibration 2026",
          "goldCardThresh": "Exemptions effective 2028",
          "policyId": "Kaiser Vyepti Policy",
          "sourceDoc": "California_2026_PA_Audit",
          "denialCode": "DENY-QL-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "CA-COM-ANTHEMBC": {
        "Gepants (Acute)": {
          "state": "CA",
          "payerName": "Anthem Blue Cross",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 generic triptans",
          "step1Duration": "≥4 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Step therapy automated at POS - checks 180-day claims for 2 unique triptan fills; new-to-plan patients submit PA immediately citing prior triptan failure",
          "contraBypass": "Yes - established CV disease; uncontrolled hypertension explicitly allows triptan bypass",
          "goldCardAvail": "SB 306 Data Calibration 2026",
          "goldCardThresh": "Exemptions effective 2028",
          "policyId": "Anthem CG-DRUG Gepants",
          "sourceDoc": "California_2026_PA_Audit",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "CGRP mAbs (SC)": {
          "state": "CA",
          "payerName": "Anthem Blue Cross",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive agents (BB, TCA, Anticonvulsant classes)",
          "step1Duration": "≥2 months each (less restrictive than Kaiser 3-class)",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Emgality/Ajovy Preferred; Aimovig Non-Preferred (step through preferred); Combination Ban: Botox + CGRP prohibited unless refractory chronic migraine with individual failures",
          "contraBypass": "Yes - contraindication to Beta-Blockers (Asthma/Bradycardia); history of kidney stones (Topiramate); partial responder documentation",
          "goldCardAvail": "SB 306 Data Calibration 2026",
          "goldCardThresh": "Exemptions effective 2028",
          "policyId": "Anthem Aimovig Policy PHARM_ALL",
          "sourceDoc": "California_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": "8.0",
          "episodicNotes": "Anthem: Episodic (<8d) = 1 oral class; Episodic (≥8d) = same as chronic (1 oral class). More lenient than most payers for episodic."
        },
        "Neurotoxins": {
          "state": "CA",
          "payerName": "Anthem Blue Cross",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 prophylactic classes (Beta-blockers, Anticonvulsants, TCAs)",
          "step1Duration": "≥2 months each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Chronic Migraine (strict ICHD-3); Medical Benefit CC-0032; dual therapy (Botox+CGRP) excluded unless partial response argued with AHS 2021 Consensus",
          "contraBypass": "Yes - documented failures; partial responder to Botox (40% reduction but remains disabled)",
          "goldCardAvail": "SB 306 Data Calibration 2026",
          "goldCardThresh": "Exemptions effective 2028",
          "policyId": "Anthem CC-0032 Botulinum Toxin",
          "sourceDoc": "California_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        }
      },
      "CA-COM-BSCA": {
        "Gepants (Acute)": {
          "state": "CA",
          "payerName": "Blue Shield of California",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥1 preferred triptan (Sumatriptan, Rizatriptan, Naratriptan, Zolmitriptan) - MORE LENIENT than Anthem",
          "step1Duration": "≥4 weeks",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Max 16 tablets/30 days; Value-Based Tiering formulary",
          "contraBypass": "Yes - CV contraindication; vascular risk factors",
          "goldCardAvail": "SB 306 Data Calibration 2026",
          "goldCardThresh": "Exemptions effective 2028",
          "policyId": "Blue Shield Nurtec/Ubrelvy Policy",
          "sourceDoc": "California_2026_PA_Audit",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "CGRP mAbs (SC)": {
          "state": "CA",
          "payerName": "Blue Shield of California",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥1 standard prophylactic drug (BB, TCA, Anticonvulsant) - RELAXED from 2 failures eff 2024",
          "step1Duration": "≥8 weeks",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Aimovig/Emgality Preferred; Ajovy may require step through preferred; Vyepti requires fail 2 SC CGRPs + Nurtec preventive; Feb 2026: Vyepti cannot combine with other CGRP",
          "contraBypass": "Yes - teratogenic contraindication; CV contraindication; documented intolerance",
          "goldCardAvail": "SB 306 Data Calibration 2026",
          "goldCardThresh": "Exemptions effective 2028",
          "policyId": "Blue Shield CGRP Policy PRV_Aimovig",
          "sourceDoc": "California_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Neurotoxins": {
          "state": "CA",
          "payerName": "Blue Shield of California",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "≥8 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Chronic Migraine (≥15 days/mo); Medical Benefit",
          "contraBypass": "Yes - oral preventive contraindications/intolerances",
          "goldCardAvail": "SB 306 Data Calibration 2026",
          "goldCardThresh": "Exemptions effective 2028",
          "policyId": "Blue Shield Botox Policy PRV_MP_BotulinumToxin",
          "sourceDoc": "California_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        },
        "CGRP mAbs (IV)": {
          "state": "CA",
          "payerName": "Blue Shield of California",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (IV)",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "Inadequate response or intolerable side effect to two of: Aimovig, Emgality, Nurtec. Not being used in combination with another cGRP antagonist for preventive treatment.",
          "step1Duration": "≥8 weeks each",
          "step2Req": "≥2 SC CGRPs (Aimovig/Emgality) + Nurtec preventive",
          "step2Duration": "Documented failure/intolerance",
          "quantityLimit": "Strict criteria; Feb 2026: cannot combine with another CGRP antagonist",
          "contraBypass": "Yes - inability to self-inject; SC CGRP failures documented",
          "goldCardAvail": "SB 306 Data Calibration 2026",
          "goldCardThresh": "Exemptions effective 2028",
          "policyId": "Blue Shield Vyepti Policy eptinezumab-jjmr",
          "sourceDoc": "Q1-2026-Policy-Refresh",
          "denialCode": "DENY-QL-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null,
          "concurrentTherapy": "Inadequate response or intolerable side effect to two of: Aimovig, Emgality, Nurtec. Not being used in combination with another cGRP antagonist for preventive treatment."
        }
      },
      "CA-MAC-NORIDIAN": {
        "Neurotoxins": {
          "state": "CA",
          "payerName": "Noridian Healthcare Solutions",
          "payerType": "Medicare MAC",
          "lob": "Part B",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "CMS launched an Ambulatory Surgical Center (ASC) prior authorization demonstration for botulinum toxin in California effective January 19, 2026. Additionally, Noridian finalized an updated botulinum toxin LCD effective February 22, 2026. New chronic migraine criteria: (a) headaches ≥15 days/month, ≥8 migraine days/month, ≥4 hours/migraine day, present ≥3 months; (b) trial and inadequate response to a 2-month trial of at least 1 agent in any 2 of: antidepressant class, beta-blocker class, or anti",
          "step1Duration": "Documented in chart",
          "step2Req": "CMS launched an Ambulatory Surgical Center (ASC) prior authorization demonstration for botulinum toxin in California effective January 19, 2026. Additionally, Noridian finalized an updated botulinum toxin LCD effective February 22, 2026. New chronic migraine criteria: (a) headaches ≥15 days/month, ≥8 migraine days/month, ≥4 hours/migraine day, present ≥3 months; (b) trial and inadequate response to a 2-month trial of at least 1 agent in any 2 of: antidepressant class, beta-blocker class, or anti",
          "step2Duration": null,
          "quantityLimit": "155-200 units/12 weeks; LCD DL39909 replacing L35170 eff 1/1/2026; strict ICD-10 (G43.709/G43.719 required - R51.9 autodeny); headache diary mandate (≥15 HA days, ≥8 migraine features); 12-week frequency strict; HOPD PA mandatory CPT 64615",
          "contraBypass": "Yes - documented in medical record with specific diagnosis codes and headache diary metrics",
          "goldCardAvail": "No (Federal Medicare)",
          "goldCardThresh": null,
          "policyId": "LCD DL39909",
          "sourceDoc": "Q1-2026-Policy-Refresh",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series.",
          "siteOfCare": "CMS launched an Ambulatory Surgical Center (ASC) prior authorization demonstration for botulinum toxin in California effective January 19, 2026. Additionally, Noridian finalized an updated botulinum toxin LCD effective February 22, 2026. New chronic migraine criteria: (a) headaches ≥15 days/month, ≥"
        }
      },
      "AZ-COM-BCBSAZ": {
        "CGRP mAbs (SC)": {
          "state": "AZ",
          "payerName": "Blue Cross Blue Shield of Arizona",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral classes",
          "step1Duration": "6-8 weeks",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "PREFERRED: Aimovig, Emgality; Ajovy excluded (step-within-step); ⚠️ DUAL THERAPY BAN",
          "contraBypass": "Yes - teratogenic; cognitive; respiratory",
          "goldCardAvail": "✓",
          "goldCardThresh": "80%",
          "policyId": "BCBSAZ Policy",
          "sourceDoc": "Arizona_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Neurotoxins": {
          "state": "AZ",
          "payerName": "Blue Cross Blue Shield AZ",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes; may require CGRP trial first",
          "step1Duration": "Trial required",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "155 units/12 weeks",
          "contraBypass": "Yes; Dual therapy via AHS Consensus appeal",
          "goldCardAvail": "No state mandate",
          "goldCardThresh": null,
          "policyId": "BCBSAZ Medical Policy",
          "sourceDoc": "Arizona_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        },
        "Gepants (Acute)": {
          "state": "AZ",
          "payerName": "Blue Cross Blue Shield of Arizona",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 generic triptans",
          "step1Duration": "Documented",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "QL 16/30d; Cluster Headache override difficult",
          "contraBypass": "Yes - CV contraindication",
          "goldCardAvail": "✓",
          "goldCardThresh": "80%",
          "policyId": "BCBSAZ Policy",
          "sourceDoc": "Arizona_2026_PA_Audit",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Gepants (Preventive)": {
          "state": "AZ",
          "payerName": "BCBS Arizona",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Preventive)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": null,
          "step1Duration": null,
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": null,
          "contraBypass": "No dual therapy with CGRP acute without documentation",
          "goldCardAvail": "No",
          "goldCardThresh": null,
          "policyId": null,
          "sourceDoc": "Arizona_2026_PA_Audit.docx",
          "denialCode": "DENY-DUAL-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "Dual therapy restriction - requires partial response documentation"
        }
      },
      "AZ-COM-UHC": {
        "Gepants (Acute)": {
          "state": "AZ",
          "payerName": "UnitedHealthcare",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 triptans",
          "step1Duration": "Trial required",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Plan dependent",
          "contraBypass": "Yes - CV contraindication",
          "goldCardAvail": "Yes (UHC National)",
          "goldCardThresh": "≥92% approval rate",
          "policyId": "UHC CGRP Policy",
          "sourceDoc": "Q1-2026-Policy-Refresh",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "Diagnosis of migraine headaches with or without aura required"
        },
        "CGRP mAbs (SC)": {
          "state": "AZ",
          "payerName": "UnitedHealthcare",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral classes",
          "step1Duration": "Trial required",
          "step2Req": "Ajovy excluded/Tier 3; Qulipta may require injectable step",
          "step2Duration": null,
          "quantityLimit": "Monthly supply; Aimovig/Emgality preferred",
          "contraBypass": "Yes",
          "goldCardAvail": "Yes (UHC National)",
          "goldCardThresh": "≥92% approval rate",
          "policyId": "UHC CGRP Policy",
          "sourceDoc": "Arizona_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "CGRP mAbs (IV)": {
          "state": "AZ",
          "payerName": "UnitedHealthcare Arizona",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (IV)",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 SC CGRP mAbs (Aimovig AND Emgality)",
          "step1Duration": "≥3 months EACH",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "J3032; Exception: inability to self-inject bypasses SC step",
          "contraBypass": "Yes - arthritis; cognitive; needle phobia",
          "goldCardAvail": "✓",
          "goldCardThresh": "CPT-specific",
          "policyId": "UHC Vyepti",
          "sourceDoc": "Arizona_2026_PA_Audit",
          "denialCode": "DENY-QL-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "AZ-MCD-AHCCCS": {
        "CGRP mAbs (SC)": {
          "state": "AZ",
          "payerName": "AHCCCS Fee-For-Service",
          "payerType": "Medicaid FFS",
          "lob": "Medicaid",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "≥6 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "PREFERRED: Aimovig, Emgality; Policy 310-V override",
          "contraBypass": "Yes - teratogenic; cognitive; respiratory; HB 2449 mental health",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "AHCCCS 310-V",
          "sourceDoc": "Arizona_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Gepants (Acute)": {
          "state": "AZ",
          "payerName": "AHCCCS Fee-For-Service",
          "payerType": "Medicaid FFS",
          "lob": "Medicaid",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 preferred triptans",
          "step1Duration": "Recent (180d) or documented",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "NON-PREFERRED: Ubrelvy, Nurtec, Reyvow; HB 2621 form required",
          "contraBypass": "Yes - CV contraindication; SUD history",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "AHCCCS PDL",
          "sourceDoc": "Arizona_2026_PA_Audit",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "AZ-MCD-UHC": {
        "CGRP mAbs (SC)": {
          "state": "AZ",
          "payerName": "UnitedHealthcare Community Plan",
          "payerType": "Medicaid MCO",
          "lob": "Medicaid",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "Per AHCCCS FFS PDL + administrative layers",
          "step1Duration": "Trial required",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "PDL limits",
          "contraBypass": "Yes",
          "goldCardAvail": "No",
          "goldCardThresh": null,
          "policyId": "UHC Community Plan Policy",
          "sourceDoc": "Arizona_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "AZ-COM-CIGNA": {
        "Gepants (Acute)": {
          "state": "AZ",
          "payerName": "Cigna Healthcare AZ",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 triptans",
          "step1Duration": "Trial required",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Strict QL",
          "contraBypass": "Yes - CV contraindication",
          "goldCardAvail": "No state mandate",
          "goldCardThresh": null,
          "policyId": "Cigna Medical Policy",
          "sourceDoc": "Arizona_2026_PA_Audit",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Neurotoxins": {
          "state": "AZ",
          "payerName": "Cigna Healthcare Arizona",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "≥3 months documented",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "⚠️ HEADACHE DIARY MANDATE (3mo); MOH denial if overusing acute meds",
          "contraBypass": "Yes - oral contraindications",
          "goldCardAvail": "Statutory",
          "goldCardThresh": null,
          "policyId": "Cigna Botox",
          "sourceDoc": "Arizona_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        }
      },
      "AZ-MAC-NORIDIAN": {
        "Neurotoxins": {
          "state": "AZ",
          "payerName": "Noridian Healthcare Solutions",
          "payerType": "Medicare MAC",
          "lob": "Part B",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "Noridian finalized an updated botulinum toxin LCD effective February 22, 2026. New chronic migraine criteria: (a) headaches ≥15 days/month, ≥8 migraine days/month, ≥4 hours/migraine day, present ≥3 months; (b) trial and inadequate response to a 2-month trial of at least 1 agent in any 2 of: antidepressant class, beta-blocker class, or antiepileptic class; (c) enhanced documentation requirements at baseline and following each injection session.",
          "step1Duration": "Adequate trial",
          "step2Req": "Noridian finalized an updated botulinum toxin LCD effective February 22, 2026. New chronic migraine criteria: (a) headaches ≥15 days/month, ≥8 migraine days/month, ≥4 hours/migraine day, present ≥3 months; (b) trial and inadequate response to a 2-month trial of at least 1 agent in any 2 of: antidepressant class, beta-blocker class, or antiepileptic class; (c) enhanced documentation requirements at baseline and following each injection session.",
          "step2Duration": null,
          "quantityLimit": "155 units/12 weeks; specific ICD-10 codes only",
          "contraBypass": "Yes",
          "goldCardAvail": "N/A (Federal)",
          "goldCardThresh": null,
          "policyId": "LCD DL39909",
          "sourceDoc": "Q1-2026-Policy-Refresh",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "Diagnosis of chronic migraines defined as 15 or more headache days per month for >3 months; 5 attacks; 8 days with specific features; documentation of concurrent CGRP therapy required.",
          "siteOfCare": "Noridian finalized an updated botulinum toxin LCD effective February 22, 2026. New chronic migraine criteria: (a) headaches ≥15 days/month, ≥8 migraine days/month, ≥4 hours/migraine day, present ≥3 months; (b) trial and inadequate response to a 2-month trial of at least 1 agent in any 2 of: antidepr"
        }
      },
      "NV-MCD-NVMEDICAID": {
        "Gepants (Acute)": {
          "state": "NV",
          "payerName": "Nevada Medicaid",
          "payerType": "Medicaid FFS",
          "lob": "Medicaid",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥1 triptan (Single PDL 2026)",
          "step1Duration": "Trial required",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Nurtec 16/30d preferred, Ubrelvy non-preferred",
          "contraBypass": "Yes - CV contraindication",
          "goldCardAvail": "No",
          "goldCardThresh": null,
          "policyId": "Single PDL (sPDL)",
          "sourceDoc": "Nevada_2026_PA_Audit_Report",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "CGRP mAbs (SC)": {
          "state": "NV",
          "payerName": "Nevada Medicaid",
          "payerType": "Medicaid FFS",
          "lob": "Medicaid",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥1 oral preventive class",
          "step1Duration": "Trial required",
          "step2Req": "Fail preferred CGRP before Ajovy/Vyepti",
          "step2Duration": null,
          "quantityLimit": "Aimovig/Emgality preferred",
          "contraBypass": "Yes",
          "goldCardAvail": "No",
          "goldCardThresh": null,
          "policyId": "Single PDL (sPDL)",
          "sourceDoc": "Nevada_2026_PA_Audit_Report",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Neurotoxins": {
          "state": "NV",
          "payerName": "Nevada Medicaid",
          "payerType": "Medicaid FFS",
          "lob": "Medicaid",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 different oral prophylactic classes; rule out MOH",
          "step1Duration": "Trial required",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "155 units/12 weeks",
          "contraBypass": "Yes",
          "goldCardAvail": "No",
          "goldCardThresh": null,
          "policyId": "NV Medicaid MSM Ch 1200",
          "sourceDoc": "Nevada_2026_PA_Audit_Report",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        }
      },
      "NV-COM-UHC": {
        "Gepants (Acute)": {
          "state": "NV",
          "payerName": "UnitedHealthcare/Health Plan of Nevada",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 triptans (Fail 2 strict)",
          "step1Duration": "Trial required",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Plan dependent",
          "contraBypass": "Yes - CV contraindication",
          "goldCardAvail": "Yes (AB 463)",
          "goldCardThresh": "2 business days",
          "policyId": "UHC Policy",
          "sourceDoc": "Nevada_2026_PA_Audit_Report",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "CGRP mAbs (SC)": {
          "state": "NV",
          "payerName": "UnitedHealthcare/Health Plan of Nevada",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral classes",
          "step1Duration": "6+ weeks each",
          "step2Req": "Qulipta may require injectable step first",
          "step2Duration": null,
          "quantityLimit": "Aimovig/Emgality preferred",
          "contraBypass": "Yes - needle phobia bypass",
          "goldCardAvail": "Yes (AB 463)",
          "goldCardThresh": "2 business days",
          "policyId": "UHC Policy",
          "sourceDoc": "Nevada_2026_PA_Audit_Report",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Neurotoxins": {
          "state": "NV",
          "payerName": "UnitedHealthcare/Health Plan of Nevada",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventives; Dual therapy denied (cite AHS Consensus)",
          "step1Duration": "Trial required",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "155 units/12 weeks",
          "contraBypass": "Yes",
          "goldCardAvail": "Yes (AB 463)",
          "goldCardThresh": "2 business days",
          "policyId": "UHC Medical Policy",
          "sourceDoc": "Nevada_2026_PA_Audit_Report",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        }
      },
      "NV-COM-ELEV": {
        "Gepants (Acute)": {
          "state": "NV",
          "payerName": "Anthem Blue Cross Blue Shield NV",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 triptans",
          "step1Duration": "Trial required",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Nurtec preferred; Ubrelvy may require Nurtec step",
          "contraBypass": "Yes - CV contraindication",
          "goldCardAvail": "Yes (AB 463)",
          "goldCardThresh": "2 business days",
          "policyId": "Anthem Policy",
          "sourceDoc": "Nevada_2026_PA_Audit_Report",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "CGRP mAbs (SC)": {
          "state": "NV",
          "payerName": "Anthem BCBS Nevada",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral classes",
          "step1Duration": "≥1 month each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Emgality/Ajovy may be preferred (varies); Nevada Select list may exclude high-cost brands",
          "contraBypass": "Yes - teratogenic; cognitive; respiratory",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "Anthem Nevada",
          "sourceDoc": "Nevada_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": "8.0",
          "episodicNotes": "Anthem: Episodic (<8d) = 1 oral class; Episodic (≥8d) = same as chronic (1 oral class). More lenient than most payers for episodic."
        }
      },
      "NV-MAC-NORIDIAN": {
        "Neurotoxins": {
          "state": "NV",
          "payerName": "Noridian Healthcare Solutions",
          "payerType": "Medicare MAC",
          "lob": "Part B",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "Requires inadequate response to at least one agent in two classes of oral medications AND documentation of prior CGRP therapy. Also requires objective documentation of functional disability (e.g., MIDAS, HIT-6).",
          "step1Duration": "Adequate trial",
          "step2Req": "Requires inadequate response to at least one agent in two classes of oral medications AND documentation of prior CGRP therapy. Also requires objective documentation of functional disability (e.g., MIDAS, HIT-6).",
          "step2Duration": null,
          "quantityLimit": "155 units/12 weeks",
          "contraBypass": "Yes",
          "goldCardAvail": "N/A (Federal)",
          "goldCardThresh": null,
          "policyId": "LCD L35170",
          "sourceDoc": "Q1-2026-Policy-Refresh",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "Requires inadequate response to at least one agent in two classes of oral medications AND documentation of prior CGRP therapy. Also requires objective documentation of functional disability (e.g., MIDAS, HIT-6)."
        }
      },
      "NM-COM-PRESBYNM": {
        "CGRP mAbs (SC)": {
          "state": "NM",
          "payerName": "Presbyterian Health Plan",
          "payerType": "Commercial/Medicaid",
          "lob": "Commercial/Medicaid",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "1-2 oral classes",
          "step1Duration": "2-3 months",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Aimovig/Emgality typically preferred; Vyepti requires SC failure first",
          "contraBypass": "Yes - teratogenic; cognitive; respiratory",
          "goldCardAvail": "⚠️ NMAC 13.10.31.12",
          "goldCardThresh": "90%",
          "policyId": "Presbyterian Policy",
          "sourceDoc": "New_Mexico_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Neurotoxins": {
          "state": "NM",
          "payerName": "Presbyterian Health Plan",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "Per closed formulary; Stanson Health/Evolent delegation",
          "step1Duration": "Trial required",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "155 units/12 weeks",
          "contraBypass": "Yes",
          "goldCardAvail": "No state mandate",
          "goldCardThresh": null,
          "policyId": "Presbyterian Medical Policy",
          "sourceDoc": "New_Mexico_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        }
      },
      "NM-COM-BCBSNM": {
        "CGRP mAbs (SC)": {
          "state": "NM",
          "payerName": "Blue Cross Blue Shield of New Mexico",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 categories (e.g. Anticonvulsant AND Beta-blocker)",
          "step1Duration": "≥2 months each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Tier 3 PA; ⚠️ UM outsourced to Carelon/EviCore Jan 2026",
          "contraBypass": "Yes - teratogenic; cognitive; respiratory",
          "goldCardAvail": "⚠️ NMAC 13.10.31.12",
          "goldCardThresh": "90%",
          "policyId": "BCBSNM Policy",
          "sourceDoc": "New_Mexico_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Neurotoxins": {
          "state": "NM",
          "payerName": "BCBS New Mexico",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes; J0585 requires NDC and exact units",
          "step1Duration": "Trial required",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "155 units/12 weeks; JW modifier for wastage",
          "contraBypass": "Yes",
          "goldCardAvail": "No state mandate",
          "goldCardThresh": null,
          "policyId": "BCBSNM Medical Policy",
          "sourceDoc": "New_Mexico_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        },
        "Gepants (Acute)": {
          "state": "NM",
          "payerName": "Blue Cross Blue Shield of New Mexico",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 preferred triptans",
          "step1Duration": "Documented",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Ubrelvy Tier 3 Preferred Brand; Nurtec Tier 3; PA still required despite 'Preferred'",
          "contraBypass": "Yes - CV contraindication",
          "goldCardAvail": "⚠️ NMAC 13.10.31.12",
          "goldCardThresh": "90%",
          "policyId": "BCBSNM Policy",
          "sourceDoc": "New_Mexico_2026_PA_Audit",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "CGRP mAbs (IV)": {
          "state": "NM",
          "payerName": "Blue Cross Blue Shield of New Mexico",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (IV)",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 orals + ≥1 SC CGRP failure",
          "step1Duration": "Documented",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Medical benefit; ⚠️ Site of Care review (home infusion preferred over HOPD)",
          "contraBypass": "Yes - needle phobia; dexterity; adherence issues",
          "goldCardAvail": "⚠️ NMAC 13.10.31.12",
          "goldCardThresh": "90%",
          "policyId": "BCBSNM dru540",
          "sourceDoc": "New_Mexico_2026_PA_Audit",
          "denialCode": "DENY-QL-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "NM-MCD-MOLINA": {
        "CGRP mAbs (SC)": {
          "state": "NM",
          "payerName": "Molina Healthcare New Mexico",
          "payerType": "Medicaid",
          "lob": "Medicaid",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 classes (Topiramate/Propranolol)",
          "step1Duration": "Documented",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "⚠️ Smart PA lookback 180d; new members = history invisible = immediate manual PA required; strict FDA labeling",
          "contraBypass": "Yes - teratogenic; cognitive; respiratory",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "Molina Policy",
          "sourceDoc": "New_Mexico_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Gepants (Preventive)": {
          "state": "NM",
          "payerName": "Molina New Mexico",
          "payerType": "Medicaid MCO",
          "lob": "Medicaid",
          "drugClass": "Gepants (Preventive)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "Fail 2 classes per state PDL",
          "step1Duration": "≥8 weeks",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "30 tabs/30 days",
          "contraBypass": "Yes - standard",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": null,
          "sourceDoc": "New_Mexico_2026_PA_Audit.docx",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "FALLBACK - follows state PDL"
        }
      },
      "NM-MCD-PRESBYHEALTH": {
        "CGRP mAbs (SC)": {
          "state": "NM",
          "payerName": "Presbyterian Turquoise Care",
          "payerType": "Medicaid MCO",
          "lob": "Medicaid",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "Strict 2026 Statewide PDL compliance",
          "step1Duration": "Trial required",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "PDL limits",
          "contraBypass": "Yes",
          "goldCardAvail": "No",
          "goldCardThresh": null,
          "policyId": "NM Statewide PDL",
          "sourceDoc": "New_Mexico_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "NM-MAC-NOVITAS": {
        "Neurotoxins": {
          "state": "NM",
          "payerName": "Novitas Solutions",
          "payerType": "Medicare MAC",
          "lob": "Part B",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "Per LCD L38809",
          "step1Duration": "Adequate trial",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "155 units/12 weeks",
          "contraBypass": "Yes",
          "goldCardAvail": "N/A (Federal)",
          "goldCardThresh": null,
          "policyId": "LCD L38809",
          "sourceDoc": "New_Mexico_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        }
      },
      "OK-COM-BCBSOK": {
        "CGRP mAbs (SC)": {
          "state": "OK",
          "payerName": "Blue Cross Blue Shield Oklahoma",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral classes (Beta-blocker/TCA/Anticonvulsant)",
          "step1Duration": "≥2 months each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "HB 3190: 72hr urgent; HB 1808: 3-year PA validity for chronic maintenance",
          "contraBypass": "Yes - teratogenic; cognitive; respiratory",
          "goldCardAvail": "⚠️ HB 3190/1808 protections",
          "goldCardThresh": null,
          "policyId": "BCBSOK Formulary",
          "sourceDoc": "Oklahoma_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Neurotoxins": {
          "state": "OK",
          "payerName": "BCBS Oklahoma",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes; JW/JZ modifier required",
          "step1Duration": "Trial required",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "155 units/12 weeks; specific muscle groups listed",
          "contraBypass": "Yes",
          "goldCardAvail": "No (HB 3190/1808 transparency)",
          "goldCardThresh": null,
          "policyId": "BCBSOK Medical Policy",
          "sourceDoc": "Oklahoma_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        },
        "Gepants (Acute)": {
          "state": "OK",
          "payerName": "Blue Cross Blue Shield Oklahoma",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 triptans (Sumatriptan/Rizatriptan)",
          "step1Duration": "Documented",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "QL: 16 tabs/30 days; HCSC division; Prime Therapeutics",
          "contraBypass": "Yes - CV contraindication",
          "goldCardAvail": "⚠️ HB 3190 continuity (60 days)",
          "goldCardThresh": null,
          "policyId": "BCBSOK Formulary",
          "sourceDoc": "Oklahoma_2026_PA_Audit",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "OK-MCD-OKCOMPLETE": {
        "CGRP mAbs (SC)": {
          "state": "OK",
          "payerName": "Oklahoma Complete Health",
          "payerType": "Medicaid MCO",
          "lob": "Medicaid",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "Per OHCA Unified PDL; MCOs cannot be more restrictive",
          "step1Duration": "Trial required",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "PDL limits",
          "contraBypass": "Yes; 60-day continuity mandate for plan changes",
          "goldCardAvail": "No",
          "goldCardThresh": null,
          "policyId": "OHCA Unified PDL",
          "sourceDoc": "Oklahoma_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "OK-MCD-AETNA": {
        "CGRP mAbs (SC)": {
          "state": "OK",
          "payerName": "SoonerSelect (All MCOs)",
          "payerType": "Medicaid MCO",
          "lob": "Medicaid",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥1 oral class (typically Topiramate)",
          "step1Duration": "≥8 weeks",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "OHCA Unified PDL governs; MCOs CANNOT impose stricter criteria than state; Aimovig/Emgality preferred",
          "contraBypass": "Yes - teratogenic; cognitive; respiratory",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "OHCA Unified PDL",
          "sourceDoc": "Oklahoma_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Neurotoxins": {
          "state": "OK",
          "payerName": "SoonerSelect (All MCOs)",
          "payerType": "Medicaid MCO",
          "lob": "Medicaid",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥3 preventive classes (antihypertensive + anticonvulsant + antidepressant)",
          "step1Duration": "Documented",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Chronic Migraine dx required; 3-class stricter than commercial 2-class",
          "contraBypass": "Yes - oral contraindications",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "OHCA Unified PDL",
          "sourceDoc": "Oklahoma_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        }
      },
      "OK-MCD-HUMANA": {
        "CGRP mAbs (SC)": {
          "state": "OK",
          "payerName": "Humana Healthy Horizons",
          "payerType": "Medicaid MCO",
          "lob": "Medicaid",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "Per OHCA Unified PDL",
          "step1Duration": "Trial required",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "PDL limits",
          "contraBypass": "Yes; PA valid 6 months-3 years for chronic conditions",
          "goldCardAvail": "No",
          "goldCardThresh": null,
          "policyId": "OHCA Unified PDL",
          "sourceDoc": "Oklahoma_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "KY-COM-ELEV": {
        "CGRP mAbs (SC)": {
          "state": "KY",
          "payerName": "Anthem (Elevance) KY",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "≥8 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Monthly supply",
          "contraBypass": "Yes",
          "goldCardAvail": "No state mandate",
          "goldCardThresh": null,
          "policyId": "Anthem KY Policy",
          "sourceDoc": "Kentucky_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": "8.0",
          "episodicNotes": "Anthem: Episodic (<8d) = 1 oral class; Episodic (≥8d) = same as chronic (1 oral class). More lenient than most payers for episodic."
        }
      },
      "KY-COM-HUMANA": {
        "CGRP mAbs (SC)": {
          "state": "KY",
          "payerName": "Humana Kentucky",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥1-2 oral preventive classes",
          "step1Duration": "Documented",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "⚠️ Voluntary Gold Card pioneer - reducing friction vs Anthem's restrictions",
          "contraBypass": "Yes - teratogenic; cognitive; respiratory",
          "goldCardAvail": "✓ Voluntary Gold Card",
          "goldCardThresh": "90%",
          "policyId": "Humana KY Formulary",
          "sourceDoc": "Kentucky_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "KY-MA-HUMANA": {
        "Neurotoxins": {
          "state": "KY",
          "payerName": "Humana",
          "payerType": "Medicare Advantage",
          "lob": "Part B",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "Botox preferred; Myobloc non-preferred (fail Botox first)",
          "step1Duration": "Trial required",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "155 units/12 weeks",
          "contraBypass": "Yes",
          "goldCardAvail": "Yes (7-day rule compliance)",
          "goldCardThresh": "High approval rate",
          "policyId": "Humana MA Policy",
          "sourceDoc": "Kentucky_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        }
      },
      "KY-COM-UHC": {
        "CGRP mAbs (SC)": {
          "state": "KY",
          "payerName": "UnitedHealthcare",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral classes for ≥2 months; specific agents listed",
          "step1Duration": "30 days",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Monthly supply",
          "contraBypass": "Yes",
          "goldCardAvail": "Yes (National Gold Card)",
          "goldCardThresh": "≥92% approval rate",
          "policyId": "UHC CGRP Policy",
          "sourceDoc": "Q1-2026-Policy-Refresh",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Gepants (Acute)": {
          "state": "KY",
          "payerName": "UnitedHealthcare",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "Smart Edits - auto-bypass if 2 triptan claims in history",
          "step1Duration": "30 days each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Nurtec 8/30d, Ubrelvy 16/30d",
          "contraBypass": "Yes - CV contraindication",
          "goldCardAvail": "Yes (National Gold Card)",
          "goldCardThresh": "≥92% approval rate",
          "policyId": "UHC Policy",
          "sourceDoc": "Kentucky_2026_PA_Audit",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Neurotoxins": {
          "state": "KY",
          "payerName": "UnitedHealthcare",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "12-week frequency strict; 10-11 week injections denied",
          "step1Duration": "Trial required",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "155 units/12 weeks",
          "contraBypass": "Yes",
          "goldCardAvail": "Yes (National Gold Card - CPT 64615)",
          "goldCardThresh": "≥92% approval rate",
          "policyId": "UHC Medical Policy",
          "sourceDoc": "Kentucky_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        }
      },
      "IL-COM-BCBSIL": {
        "CGRP mAbs (SC)": {
          "state": "IL",
          "payerName": "Blue Cross Blue Shield of Illinois",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥1 oral preventive class (Beta-blocker, TCA, or Anticonvulsant)",
          "step1Duration": "≥2 months",
          "step2Req": "Intra-class step: Aimovig often NON-PREFERRED (Tier 4) - requires step through Emgality or Ajovy",
          "step2Duration": "Documented failure",
          "quantityLimit": "Emgality/Ajovy PREFERRED; Aimovig requires step through preferred agents",
          "contraBypass": "Yes - intolerance; contraindication; teratogenic bypass",
          "goldCardAvail": "Public Act 103-0593 (July 1 2026)",
          "goldCardThresh": "≥90% on ≥50 PAs",
          "policyId": "BCBSIL Performance Drug List",
          "sourceDoc": "Illinois_2026_PA_Audit_Strategy",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Neurotoxins": {
          "state": "IL",
          "payerName": "Blue Cross Blue Shield of Illinois",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "≥2 months each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "J0585 + 64615; Chronic Migraine (≥15 days/mo); PA via Availity or Carelon; dual therapy (Botox+CGRP) HIGH RESTRICTION - cite AHS Consensus Statement for refractory",
          "contraBypass": "Yes - oral preventive contraindications; dual therapy requires 'partial responder' documentation",
          "goldCardAvail": "Public Act 103-0593 (July 1 2026)",
          "goldCardThresh": "≥90% on ≥50 PAs",
          "policyId": "BCBSIL Medical Policy",
          "sourceDoc": "Illinois_2026_PA_Audit_Strategy",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        },
        "Gepants (Acute)": {
          "state": "IL",
          "payerName": "Blue Cross Blue Shield of Illinois",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 triptans (Sumatriptan, Rizatriptan, Eletriptan) - payer checks claims history",
          "step1Duration": "Specific dates of trial required for each triptan",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Ubrelvy 16 doses/month; override requires documentation of 'Risk of Medication Overuse Headache (MOH)'",
          "contraBypass": "Yes - CV risk factors = 'Contraindication to vasoconstrictive agents' bypasses triptan step entirely",
          "goldCardAvail": "Public Act 103-0593 (July 1 2026)",
          "goldCardThresh": "≥90% on ≥50 PAs in preceding 12 months",
          "policyId": "BCBSIL Prime Performance Drug List",
          "sourceDoc": "Illinois_2026_PA_Audit_Strategy",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "CGRP mAbs (IV)": {
          "state": "IL",
          "payerName": "Blue Cross Blue Shield of Illinois",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (IV)",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "≥2 months each",
          "step2Req": "PA Required",
          "step2Duration": "Documented",
          "quantityLimit": "J3032; Medical Benefit",
          "contraBypass": "Yes - inability to self-inject; GI intolerance/gastroparesis",
          "goldCardAvail": "Public Act 103-0593 (July 1 2026)",
          "goldCardThresh": "≥90% on ≥50 PAs",
          "policyId": "BCBSIL Medical Policy",
          "sourceDoc": "Illinois_2026_PA_Audit_Strategy",
          "denialCode": "DENY-STEP-005",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Gepants (Preventive)": {
          "state": "IL",
          "payerName": "BCBS Illinois",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Preventive)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "≥8 weeks",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "16 tabs/30 days",
          "contraBypass": "Unknown",
          "goldCardAvail": "No",
          "goldCardThresh": null,
          "policyId": null,
          "sourceDoc": "Illinois_2026_PA_Audit.md",
          "denialCode": "DENY-DUAL-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "One CGRP at a time policy; cannot combine with Botox"
        }
      },
      "IL-COM-UHC": {
        "CGRP mAbs (IV)": {
          "state": "IL",
          "payerName": "UnitedHealthcare Illinois",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (IV)",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "≥8 weeks each",
          "step2Req": "Part B Step: Fail ≥1 self-injected CGRP (Aimovig/Emgality) before IV Vyepti; PLUS Site of Care restriction - HOPD routinely DENIED",
          "step2Duration": "Documented SC failure + Site of Care review",
          "quantityLimit": "J3032; Site of Care: Home Infusion or freestanding Infusion Center PREFERRED; HOPD exception requires 'difficult venous access requiring ultrasound guidance' OR 'history of syncope/anaphylaxis requiring hospital-level resuscitation'",
          "contraBypass": "Yes - needle phobia; inability to self-administer (arthritis/cognitive impairment); difficult venous access",
          "goldCardAvail": "Public Act 103-0593 (July 1 2026)",
          "goldCardThresh": "≥90% on ≥50 PAs",
          "policyId": "UHC Part B Medical Policy",
          "sourceDoc": "Illinois_2026_PA_Audit_Strategy",
          "denialCode": "DENY-QL-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Neurotoxins": {
          "state": "IL",
          "payerName": "UnitedHealthcare Illinois",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "⚠️ ≥3 DISTINCT oral preventive classes (e.g., Topamax + Propranolol + Amitriptyline) - STRICTER than BCBSIL 2-class",
          "step1Duration": "≥8 weeks each at maximum tolerated dose; chart must explicitly state 'Trial duration: 8 weeks at maximum tolerated dose'",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Chronic Migraine (≥15 days/mo); frequency STRICT every 12 weeks - claims <84 days = automated denial; P2P focus on 'trial duration'",
          "contraBypass": "Yes - document specific drug/dosage/duration/reason for discontinuation for EACH of 3 classes",
          "goldCardAvail": "Public Act 103-0593 (July 1 2026)",
          "goldCardThresh": "≥90% on ≥50 PAs",
          "policyId": "UHC Botulinum Toxins A and B",
          "sourceDoc": "Illinois_2026_PA_Audit_Strategy",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        },
        "Gepants (Acute)": {
          "state": "IL",
          "payerName": "UnitedHealthcare Illinois",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 triptans with documented 'therapeutic failure' defined as lack of clinical response after treating ≥3 separate migraine episodes with each triptan",
          "step1Duration": "≥3 migraine episodes treated per triptan (nuance: single dose discontinuation may result in denial)",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Standard QL",
          "contraBypass": "Yes - CV contraindication",
          "goldCardAvail": "Public Act 103-0593 (July 1 2026)",
          "goldCardThresh": "≥90% on ≥50 PAs",
          "policyId": "UHC Gepant Policy",
          "sourceDoc": "Illinois_2026_PA_Audit_Strategy",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "CGRP mAbs (SC)": {
          "state": "IL",
          "payerName": "UnitedHealthcare Illinois",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "≥8 weeks each",
          "step2Req": "Intra-class step: requires Aimovig OR Emgality before Ajovy or Vyepti",
          "step2Duration": "Documented failure",
          "quantityLimit": "Aimovig/Emgality preferred; Ajovy/Vyepti require step through preferred",
          "contraBypass": "Yes - teratogenic; CV contraindication; cognitive impairment from oral preventives",
          "goldCardAvail": "Public Act 103-0593 (July 1 2026)",
          "goldCardThresh": "≥90% on ≥50 PAs",
          "policyId": "UHC CGRP Policy",
          "sourceDoc": "Illinois_2026_PA_Audit_Strategy",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "IL-MCD-MERIDIAN": {
        "CGRP mAbs (SC)": {
          "state": "IL",
          "payerName": "Meridian Health Plan of Illinois",
          "payerType": "Medicaid MCO",
          "lob": "Medicaid",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes per HFS PDL",
          "step1Duration": "≥8 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "⚠️ CRITICAL 2026 RESTRICTION: 'One CGRP at a time' rule - blocks concurrent Nurtec (preventive 16 tabs/mo) + Botox; WORKAROUND: prescribe Nurtec as ACUTE (8 tabs/mo) to bypass preventive duplicate logic OR submit medical necessity appeal for refractory status",
          "contraBypass": "Yes - teratogenic; CV contraindication; documented intolerance",
          "goldCardAvail": "Public Act 103-0593 (July 1 2026)",
          "goldCardThresh": "≥90% on ≥50 PAs",
          "policyId": "HFS PDL / Meridian Policy",
          "sourceDoc": "Illinois_2026_PA_Audit_Strategy",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Gepants (Acute)": {
          "state": "IL",
          "payerName": "Meridian Health Plan of Illinois",
          "payerType": "Medicaid MCO",
          "lob": "Medicaid",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 triptans per HFS PDL",
          "step1Duration": "≥4 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Ubrelvy PREFERRED with PA confirming triptan failure; ⚠️ STRICT QL: 16 tablets/30 days - exceeding requires 'medical necessity' review (rarely approved without severe rebound documentation)",
          "contraBypass": "Yes - CV contraindication",
          "goldCardAvail": "Public Act 103-0593 (July 1 2026)",
          "goldCardThresh": "≥90% on ≥50 PAs",
          "policyId": "HFS PDL",
          "sourceDoc": "Illinois_2026_PA_Audit_Strategy",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Neurotoxins": {
          "state": "IL",
          "payerName": "Meridian Health Plan of Illinois",
          "payerType": "Medicaid MCO",
          "lob": "Medicaid",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "≥8 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Chronic Migraine; ⚠️ One CGRP rule applies - cannot add CGRP mAb to Botox without high-level medical necessity appeal",
          "contraBypass": "Yes - oral preventive contraindications",
          "goldCardAvail": "Public Act 103-0593 (July 1 2026)",
          "goldCardThresh": "≥90% on ≥50 PAs",
          "policyId": "HFS PDL / Meridian Medical",
          "sourceDoc": "Illinois_2026_PA_Audit_Strategy",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        },
        "CGRP mAbs (IV)": {
          "state": "IL",
          "payerName": "Meridian Health Plan of Illinois",
          "payerType": "Medicaid MCO",
          "lob": "Medicaid",
          "drugClass": "CGRP mAbs (IV)",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "≥8 weeks each",
          "step2Req": "Medical PA Required",
          "step2Duration": "Documented",
          "quantityLimit": "J3032; Medical Benefit",
          "contraBypass": "Yes - inability to self-inject",
          "goldCardAvail": "Public Act 103-0593 (July 1 2026)",
          "goldCardThresh": "≥90% on ≥50 PAs",
          "policyId": "HFS PDL / Meridian Medical",
          "sourceDoc": "Illinois_2026_PA_Audit_Strategy",
          "denialCode": "DENY-QL-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "GA-COM-ELEV": {
        "CGRP mAbs (SC)": {
          "state": "GA",
          "payerName": "Anthem Blue Cross Blue Shield of Georgia",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥1-2 oral preventive classes (varies by specific plan - National vs Select); verify plan formulary",
          "step1Duration": "≥8-12 weeks",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Emgality/Ajovy generally PREFERRED (plan dependent); Aimovig may be non-preferred/higher copay",
          "contraBypass": "Yes - teratogenic; CV contraindication; documented intolerance",
          "goldCardAvail": "SB 5 - Jan 1 2026 implementation",
          "goldCardThresh": "90% threshold",
          "policyId": "Anthem CGRP Policy",
          "sourceDoc": "Georgia_2026_PA_Audit_Strategy",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": "8.0",
          "episodicNotes": "Anthem: Episodic (<8d) = 1 oral class; Episodic (≥8d) = same as chronic (1 oral class). More lenient than most payers for episodic."
        },
        "Neurotoxins": {
          "state": "GA",
          "payerName": "Anthem Blue Cross Blue Shield of Georgia",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "≥8 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Chronic Migraine; ⚠️ Dual Therapy (Botox+CGRP) classified as 'duplicative therapy' - will DENY second agent; appeal requires 'partial responder' + AHS Consensus Statement reference",
          "contraBypass": "Yes - oral preventive contraindications; dual therapy requires refractory documentation",
          "goldCardAvail": "SB 5 - Jan 1 2026 implementation",
          "goldCardThresh": "90% threshold for CPT 64615",
          "policyId": "Anthem Botox Policy",
          "sourceDoc": "Georgia_2026_PA_Audit_Strategy",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        },
        "Gepants (Acute)": {
          "state": "GA",
          "payerName": "Anthem Blue Cross Blue Shield of Georgia",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 triptans; failure defined as 'no significant reduction in headache pain/intensity within 2 hours of dosing',Documented per Anthem definition,N/A",
          "step1Duration": null,
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Gepants Tier 3; CV Exception = primary bypass",
          "contraBypass": "Yes - CV risk factors (CAD, stroke history, uncontrolled HTN) = 'Contraindication to vasoconstrictive agents'",
          "goldCardAvail": "SB 5 - Jan 1 2026 implementation",
          "goldCardThresh": "90% threshold",
          "policyId": "Anthem Commercial Policy",
          "sourceDoc": "Georgia_2026_PA_Audit_Strategy",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "CGRP mAbs (IV)": {
          "state": "GA",
          "payerName": "Anthem Blue Cross Blue Shield of Georgia",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (IV)",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "≥8 weeks each",
          "step2Req": "Fail self-administered CGRP OR document inability to self-inject",
          "step2Duration": "Documented",
          "quantityLimit": "J3032; Vyepti strictly reserved for patients who CANNOT self-inject; document needle phobia; arthritis; tremor; poor adherence history",
          "contraBypass": "Yes - needle phobia; physical disability; poor adherence to self-administered meds",
          "goldCardAvail": "SB 5 - Jan 1 2026 implementation",
          "goldCardThresh": "90% threshold",
          "policyId": "Anthem Vyepti Policy",
          "sourceDoc": "Georgia_2026_PA_Audit_Strategy",
          "denialCode": "DENY-QL-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "GA-COM-UHC": {
        "CGRP mAbs (SC)": {
          "state": "GA",
          "payerName": "UnitedHealthcare Georgia",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "≥8 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Aimovig/Emgality often PREFERRED; Ajovy frequently excluded or Tier 3/4",
          "contraBypass": "Yes - teratogenic; CV contraindication; documented intolerance",
          "goldCardAvail": "UHC National Gold Card ACTIVE",
          "goldCardThresh": "92% threshold",
          "policyId": "UHC CGRP Policy",
          "sourceDoc": "Georgia_2026_PA_Audit_Strategy",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Gepants (Acute)": {
          "state": "GA",
          "payerName": "UnitedHealthcare Georgia",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 triptans",
          "step1Duration": "Documented failure",
          "step2Req": "Must fail oral gepants (Ubrelvy OR Nurtec)",
          "step2Duration": "Documented failure",
          "quantityLimit": "⚠️ Highest scrutiny; bypass ONLY with documented 'Severe GI intolerance/Gastroparesis' rendering oral meds ineffective",
          "contraBypass": "Yes - 'Severe gastrointestinal intolerance/Gastroparesis' = only successful bypass",
          "goldCardAvail": "UHC National Gold Card",
          "goldCardThresh": "92% threshold",
          "policyId": "UHC Zavzpret Policy",
          "sourceDoc": "Georgia_2026_PA_Audit_Strategy",
          "denialCode": "DENY-STEP-005",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Neurotoxins": {
          "state": "GA",
          "payerName": "UnitedHealthcare Georgia",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "≥8 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Chronic Migraine; 12-week rule strongly enforced; ⚠️ STRICT 'no overlap' policy with CGRPs - appeal required for dual therapy",
          "contraBypass": "Yes - oral preventive contraindications",
          "goldCardAvail": "UHC National Gold Card ACTIVE",
          "goldCardThresh": "92% threshold for CPT 64615",
          "policyId": "UHC Botox Policy",
          "sourceDoc": "Georgia_2026_PA_Audit_Strategy",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        }
      },
      "GA-MCD-PEACHSTATE": {
        "CGRP mAbs (SC)": {
          "state": "GA",
          "payerName": "Peach State Health Plan",
          "payerType": "Medicaid CMO",
          "lob": "Medicaid Pharmacy",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes per Unified PDL",
          "step1Duration": "≥8-12 weeks each per PDL",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Unified PDL criteria via DCH",
          "contraBypass": "Yes - per PDL contraindication criteria",
          "goldCardAvail": "SB 5 - July 1 2026",
          "goldCardThresh": "90% threshold",
          "policyId": "Georgia Unified PDL",
          "sourceDoc": "Georgia_2026_PA_Audit_Strategy",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Gepants (Acute)": {
          "state": "GA",
          "payerName": "Peach State Health Plan",
          "payerType": "Medicaid CMO",
          "lob": "Medicaid Pharmacy",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 preferred triptans per Unified PDL",
          "step1Duration": "Per PDL",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Unified PDL criteria via DCH",
          "contraBypass": "Yes - CV contraindication per PDL",
          "goldCardAvail": "SB 5 - July 1 2026",
          "goldCardThresh": "90% threshold",
          "policyId": "Georgia Unified PDL",
          "sourceDoc": "Georgia_2026_PA_Audit_Strategy",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "GA-MAC-PALMETTO": {
        "Neurotoxins": {
          "state": "GA",
          "payerName": "Palmetto GBA",
          "payerType": "Medicare MAC",
          "lob": "Part B",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "Fail standard care (implies ≥2 oral preventive classes)",
          "step1Duration": "Documented in medical record",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "LCD L33458; Chronic Migraine STRICT: ≥15 HA days/mo; ≥8 migraine days/mo; duration ≥4 hours/day; 12-week frequency RIGID (>84 days or denial); ICD-10: G43.709; CPT 64615 + J0585",
          "contraBypass": "Yes - documented failures with specific adverse events",
          "goldCardAvail": "No - Federal Medicare (SB 5 does not apply)",
          "goldCardThresh": null,
          "policyId": "LCD L33458",
          "sourceDoc": "Georgia_2026_PA_Audit_Strategy",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        }
      },
      "KS-COM-BCBSKANSAS": {
        "Gepants (Acute)": {
          "state": "KS",
          "payerName": "Blue Cross Blue Shield Kansas",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 generic triptans (sumatriptan/rizatriptan preferred)",
          "step1Duration": "≥2 acute episodes each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Nurtec 8/30d, Ubrelvy 16/30d",
          "contraBypass": "Yes - CV contraindication; hemiplegic migraine",
          "goldCardAvail": "Pending (HB 2292)",
          "goldCardThresh": null,
          "policyId": "MP-RX-2026-MIGRAINE",
          "sourceDoc": "Kansas_PA_Audit__Migraine_Drug_Defense",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "CGRP mAbs (SC)": {
          "state": "KS",
          "payerName": "Blue Cross Blue Shield Kansas",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes at therapeutic dose (beta-blocker ≥80mg propranolol, anticonvulsant ≥100mg topiramate, TCA ≥25mg amitriptyline, SNRI ≥75mg venlafaxine)",
          "step1Duration": "≥8 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Monthly supply per label",
          "contraBypass": "Yes - teratogenic contraindication (females); CV contraindication for beta-blockers; cognitive impairment for topiramate",
          "goldCardAvail": "Pending (HB 2292)",
          "goldCardThresh": null,
          "policyId": "MP-RX-2026-CGRP",
          "sourceDoc": "Kansas_PA_Audit__Migraine_Drug_Defense",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Neurotoxins": {
          "state": "KS",
          "payerName": "Blue Cross Blue Shield Kansas",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "≥8 weeks each at therapeutic dose",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "155-200 units/12 weeks",
          "contraBypass": "Yes - oral preventive contraindications documented",
          "goldCardAvail": "Pending (HB 2292)",
          "goldCardThresh": null,
          "policyId": "MP-MED-2026-BOTOX",
          "sourceDoc": "Kansas_PA_Audit__Migraine_Drug_Defense",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        }
      },
      "KS-COM-UHC": {
        "Gepants (Acute)": {
          "state": "KS",
          "payerName": "UnitedHealthcare Kansas",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "⚠️ 'SmartPA': 2 distinct triptan fills in preceding 180 days (claims history screened)",
          "step1Duration": "Real-time POS check",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Automated rejection if no triptan history; proactive historical data submission required for new patients",
          "contraBypass": "Yes - CV contraindication",
          "goldCardAvail": "✓ Gold Card Pilot",
          "goldCardThresh": ">90%",
          "policyId": "UHC SmartPA",
          "sourceDoc": "Kansas_PA_Audit",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "CGRP mAbs (SC)": {
          "state": "KS",
          "payerName": "UnitedHealthcare",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "≥8 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Monthly supply",
          "contraBypass": "Yes - standard contraindication language accepted",
          "goldCardAvail": "Pending (HB 2292)",
          "goldCardThresh": null,
          "policyId": "UHC-CGRP-2026",
          "sourceDoc": "Kansas_PA_Audit__Migraine_Drug_Defense",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Neurotoxins": {
          "state": "KS",
          "payerName": "UnitedHealthcare Kansas",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "Documented",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "⚠️ Concurrent Botox+CGRP = 'duplicative therapy' denial unless 'synergistic necessity' proven via appeal",
          "contraBypass": "Yes - oral contraindications",
          "goldCardAvail": "✓ Gold Card Pilot",
          "goldCardThresh": ">90%",
          "policyId": "UHC Botox Policy",
          "sourceDoc": "Kansas_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        }
      },
      "KS-MCD-HEALTHYBLUE": {
        "CGRP mAbs (SC)": {
          "state": "KS",
          "payerName": "Healthy Blue Kansas (KanCare)",
          "payerType": "Medicaid MCO",
          "lob": "Medicaid",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥1 oral preventive class",
          "step1Duration": "≥8 weeks",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Elevance national UM guidelines; stricter than legacy criteria; objective efficacy proof (not subjective) required for renewal",
          "contraBypass": "Yes - teratogenic; cognitive; respiratory",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "Healthy Blue Guidelines",
          "sourceDoc": "Kansas_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Neurotoxins": {
          "state": "KS",
          "payerName": "Healthy Blue Kansas (KanCare)",
          "payerType": "Medicaid MCO",
          "lob": "Medicaid",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "⚠️ ≥3 preventive classes (antihypertensive + anticonvulsant + antidepressant)",
          "step1Duration": "Documented",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Stricter than 2-class standard; KanCare 3.0 90-day continuity EXPIRED",
          "contraBypass": "Yes - oral contraindications",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "Healthy Blue Guidelines",
          "sourceDoc": "Kansas_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        },
        "Gepants (Acute)": {
          "state": "KS",
          "payerName": "Healthy Blue Kansas",
          "payerType": "Medicaid MCO",
          "lob": "Medicaid",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 PDL triptans",
          "step1Duration": "≥4 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "KS Medicaid PDL limits apply",
          "contraBypass": "Yes - CV/hemiplegic contraindication",
          "goldCardAvail": "No",
          "goldCardThresh": null,
          "policyId": "HEALTHYBLUE-RX-2026",
          "sourceDoc": "Kansas_PA_Audit__Migraine_Drug_Defense",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "KS-MCD-SUNFLOWER": {
        "CGRP mAbs (SC)": {
          "state": "KS",
          "payerName": "Sunflower Health Plan",
          "payerType": "Medicaid MCO",
          "lob": "Medicaid",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes (Centene guidelines)",
          "step1Duration": "≥8 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Monthly supply",
          "contraBypass": "Yes - teratogenic/CV bypass",
          "goldCardAvail": "No",
          "goldCardThresh": null,
          "policyId": "SUNFLOWER-CGRP-2026",
          "sourceDoc": "Q1-2026-Policy-Refresh",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "Prior authorizations must be requested at least 5 days prior to the schedule service start date; peer-to-peer reviews requested within 3 days of denial notification."
        },
        "Gepants (Acute)": {
          "state": "KS",
          "payerName": "Sunflower Health Plan",
          "payerType": "Medicaid MCO",
          "lob": "Medicaid",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 PDL triptans",
          "step1Duration": "≥4 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "KS Medicaid PDL limits",
          "contraBypass": "Yes - CV contraindication",
          "goldCardAvail": "No",
          "goldCardThresh": null,
          "policyId": "SUNFLOWER-RX-2026",
          "sourceDoc": "Kansas_PA_Audit__Migraine_Drug_Defense",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Neurotoxins": {
          "state": "KS",
          "payerName": "Sunflower Health Plan",
          "payerType": "Medicaid MCO",
          "lob": "Medicaid",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "≥8 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "155-200 units/12 weeks",
          "contraBypass": "Yes - oral contraindications",
          "goldCardAvail": "No",
          "goldCardThresh": null,
          "policyId": "SUNFLOWER-BOTOX-2026",
          "sourceDoc": "Kansas_PA_Audit__Migraine_Drug_Defense",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        }
      },
      "MN-COM-MINNBCBS": {
        "CGRP mAbs (SC)": {
          "state": "MN",
          "payerName": "Blue Cross Blue Shield of Minnesota",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "\"≥2 oral prophylactic classes (Beta-blockers, Anticonvulsants, Antidepressants)\",≥8 weeks each",
          "step1Duration": null,
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Aimovig/Ajovy/Emgality; NO combination with other CGRP antagonists allowed; dual therapy (Botox+CGRP) = guaranteed initial denial",
          "contraBypass": "Yes - intolerance (cognitive slowing for topiramate, fatigue for beta-blockers) bypasses 8-week trial",
          "goldCardAvail": "MN §62M.07 Platinum Card",
          "goldCardThresh": "Chronic condition auth does not expire",
          "policyId": "BCBSMN CGRP Policy",
          "sourceDoc": "Minnesota_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Neurotoxins": {
          "state": "MN",
          "payerName": "Blue Cross Blue Shield of Minnesota",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral prophylaxis classes (Beta-blockers, Anticonvulsants, Antidepressants)",
          "step1Duration": "≥8 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "155-200 units/12 weeks; Chronic Migraine (≥15 HA days/mo, ≥8 migraine days); RENEWAL requires ≥7 day reduction OR ≥100 hour reduction documented",
          "contraBypass": "Yes - oral prophylaxis contraindications; vague 'doing better' notes will be denied",
          "goldCardAvail": "MN §62M.07 Platinum Card",
          "goldCardThresh": "Chronic condition auth does not expire",
          "policyId": "Policy II-16-010",
          "sourceDoc": "Minnesota_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        },
        "Gepants (Acute)": {
          "state": "MN",
          "payerName": "Blue Cross Blue Shield of Minnesota",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 triptans (sumatriptan/rizatriptan preferred),≥4 weeks each,N/A",
          "step1Duration": null,
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Non-Preferred or PA required; standard QL",
          "contraBypass": "Yes - vascular risk factors (uncontrolled HTN, Raynaud's, ischemic disease history)",
          "goldCardAvail": "MN §62M.07 Platinum Card",
          "goldCardThresh": "Chronic condition auth does not expire",
          "policyId": "BCBSMN Commercial Formulary",
          "sourceDoc": "Minnesota_2026_PA_Audit",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "MN-COM-UHC": {
        "CGRP mAbs (SC)": {
          "state": "MN",
          "payerName": "UnitedHealthcare",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral classes",
          "step1Duration": "≥6 weeks each",
          "step2Req": "Vyepti requires fail preferred injectable CGRPs",
          "step2Duration": null,
          "quantityLimit": "Aimovig/Emgality preferred",
          "contraBypass": "Yes",
          "goldCardAvail": "Yes (UHC National + Platinum Card)",
          "goldCardThresh": "≥92% approval rate",
          "policyId": "UHC CGRP Policy",
          "sourceDoc": "Minnesota_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Neurotoxins": {
          "state": "MN",
          "payerName": "UnitedHealthcare",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes; No concurrent CGRP without appeal",
          "step1Duration": "Trial required",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "155 units/12 weeks",
          "contraBypass": "Yes - cite refractory status for dual therapy",
          "goldCardAvail": "Yes (UHC National + Platinum Card)",
          "goldCardThresh": "≥92% approval rate",
          "policyId": "UHC Medical Policy",
          "sourceDoc": "Minnesota_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        }
      },
      "MN-COM-PARTNERS": {
        "CGRP mAbs (SC)": {
          "state": "MN",
          "payerName": "HealthPartners",
          "payerType": "Medicaid MCO",
          "lob": "Medicaid",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes per DHS PDL",
          "step1Duration": "≥8 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Integrated P&T; calcium channel blockers accepted as step therapy class per commercial policy",
          "contraBypass": "Yes - intolerance; CV contraindication",
          "goldCardAvail": "MN §62M.07 Platinum Card",
          "goldCardThresh": "Chronic condition auth does not expire",
          "policyId": "DHS PDL + HealthPartners Policy",
          "sourceDoc": "Minnesota_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Neurotoxins": {
          "state": "MN",
          "payerName": "HealthPartners",
          "payerType": "Medicaid MCO",
          "lob": "Medicaid",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 preventive drug categories",
          "step1Duration": "≥8 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Chronic Migraine; Medical Benefit; no concurrent CGRP",
          "contraBypass": "Yes - documented failures with calcium channel blocker alternative",
          "goldCardAvail": "MN §62M.07 Platinum Card",
          "goldCardThresh": "Chronic condition auth does not expire",
          "policyId": "HealthPartners MCD Botox",
          "sourceDoc": "Minnesota_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        },
        "Gepants (Acute)": {
          "state": "MN",
          "payerName": "HealthPartners",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 triptans - automated rejection if no oral preventive history in pharmacy claims",
          "step1Duration": "≥4 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Tier 3/4; strict step therapy enforcement via claims data algorithm",
          "contraBypass": "Yes - CV contraindication; vascular risk factors",
          "goldCardAvail": "MN §62M.07 Platinum Card",
          "goldCardThresh": "Chronic condition auth does not expire",
          "policyId": "HealthPartners Formulary",
          "sourceDoc": "Minnesota_2026_PA_Audit",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "MN-MAC-NGS": {
        "Neurotoxins": {
          "state": "MN",
          "payerName": "National Government Services",
          "payerType": "Medicare MAC",
          "lob": "Part B",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "Traditional preventive methods proven unsuccessful",
          "step1Duration": "Documented in chart",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "155-200 units/12 weeks; LCD L33646/DL39909; strict ICD-10 (G43.709/G43.719 required - G43.909 autodeny); 12-week frequency strict; JW/JZ modifiers mandatory 2026",
          "contraBypass": "Requires objective clinical scale assessment at baseline and all follow-ups; Allows concurrent CGRP use if partial response achieved but additional prophylaxis is required; Prohibits concurrent cosmetic use",
          "goldCardAvail": "No (Federal Medicare)",
          "goldCardThresh": null,
          "policyId": "LCD L33646/DL39909",
          "sourceDoc": "Q1-2026-Policy-Refresh",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "Requires objective clinical scale assessment at baseline and all follow-ups; Allows concurrent CGRP use if partial response achieved but additional prophylaxis is required; Prohibits concurrent cosmetic use"
        }
      },
      "WV-COM-HIGHBCBS": {
        "Gepants (Acute)": {
          "state": "WV",
          "payerName": "Highmark BCBS WV",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 triptans + 1 other acute",
          "step1Duration": "Trial required",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Plan dependent",
          "contraBypass": "Permitted with prescriber attestation that benefits outweigh risks",
          "goldCardAvail": "Yes (SB 833 - Procedures Only)",
          "goldCardThresh": "Drugs excluded from Gold Card",
          "policyId": "Highmark Policy",
          "sourceDoc": "Q1-2026-Policy-Refresh",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "CGRP mAbs (SC)": {
          "state": "WV",
          "payerName": "Highmark BCBS WV",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "First-Line (No oral step required per 2026 policy)",
          "step1Duration": null,
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Monthly supply",
          "contraBypass": "N/A - first-line per Highmark 2026",
          "goldCardAvail": "Yes (SB 833 - Procedures Only)",
          "goldCardThresh": "Drugs excluded from Gold Card",
          "policyId": "Highmark Commercial National Select",
          "sourceDoc": "West_Virginia_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Neurotoxins": {
          "state": "WV",
          "payerName": "Highmark BCBS WV",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "Fail CGRP or Oral Preventives; Dual Therapy Allowed (J-1207)",
          "step1Duration": "Trial required",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "155 units/12 weeks",
          "contraBypass": "Yes - partial response doctrine",
          "goldCardAvail": "Yes (SB 833 - Procedures Only)",
          "goldCardThresh": "90% approval rate",
          "policyId": "Highmark J-1207",
          "sourceDoc": "West_Virginia_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        }
      },
      "WV-MCD-BMS": {
        "Gepants (Acute)": {
          "state": "WV",
          "payerName": "West Virginia Medicaid (BMS)",
          "payerType": "Medicaid FFS",
          "lob": "Medicaid",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 preferred triptans (Sumatriptan/Rizatriptan/Naratriptan)",
          "step1Duration": "Documented",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Non-Preferred; MCOs contractually bound to BMS PDL",
          "contraBypass": "Yes - CV contraindication",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "BMS PDL",
          "sourceDoc": "West_Virginia_2026_PA_Audit",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "CGRP mAbs (SC)": {
          "state": "WV",
          "payerName": "West Virginia Medicaid (BMS)",
          "payerType": "Medicaid FFS",
          "lob": "Medicaid",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥1-2 oral preventive classes",
          "step1Duration": "≥3 months",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "PREFERRED: Aimovig, Emgality (locked behind Step 1); NON-PREFERRED: Ajovy, Vyepti (require preferred CGRP failure); ⚠️ NO AHS First-Line adoption",
          "contraBypass": "Yes - teratogenic (female childbearing potential); cognitive; respiratory",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "BMS PDL",
          "sourceDoc": "West_Virginia_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Neurotoxins": {
          "state": "WV",
          "payerName": "West Virginia Medicaid (BMS)",
          "payerType": "Medicaid FFS",
          "lob": "Medicaid",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "Documented",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Chronic (15/8); headache diary required by MCOs (Aetna Better Health/The Health Plan)",
          "contraBypass": "Yes - oral contraindications",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "BMS PDL",
          "sourceDoc": "West_Virginia_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        }
      },
      "WV-COM-HEALTHPLAN": {
        "CGRP mAbs (SC)": {
          "state": "WV",
          "payerName": "The Health Plan",
          "payerType": "Commercial/Medicaid",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral classes (Fail BB + Topiramate); 720-day lookback",
          "step1Duration": "Trial required",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Tier 3/4 placement",
          "contraBypass": "Yes",
          "goldCardAvail": "Yes (SB 833 - Procedures Only)",
          "goldCardThresh": "Drugs excluded",
          "policyId": "The Health Plan Policy",
          "sourceDoc": "West_Virginia_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Neurotoxins": {
          "state": "WV",
          "payerName": "The Health Plan",
          "payerType": "Commercial/Medicaid",
          "lob": "Commercial",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral classes + Chronic Dx",
          "step1Duration": "Trial required",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "155 units/12 weeks",
          "contraBypass": "Yes",
          "goldCardAvail": "Yes (SB 833 - Procedures Only)",
          "goldCardThresh": "Drugs excluded",
          "policyId": "The Health Plan Medical",
          "sourceDoc": "West_Virginia_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        }
      },
      "WV-ACA-CARESOURCE": {
        "CGRP mAbs (SC)": {
          "state": "WV",
          "payerName": "CareSource",
          "payerType": "Marketplace",
          "lob": "ACA Exchange",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral classes",
          "step1Duration": "Trial required",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Plan dependent",
          "contraBypass": "Yes",
          "goldCardAvail": "No Gold Card",
          "goldCardThresh": "Standard PA",
          "policyId": "CareSource WV Policy",
          "sourceDoc": "West_Virginia_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Gepants (Preventive)": {
          "state": "WV",
          "payerName": "CareSource",
          "payerType": "Marketplace",
          "lob": "ACA",
          "drugClass": "Gepants (Preventive)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "Per formulary",
          "step1Duration": "≥8 weeks",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "30 tabs/30 days",
          "contraBypass": "Member exception request for non-formulary",
          "goldCardAvail": "No",
          "goldCardThresh": null,
          "policyId": null,
          "sourceDoc": "West_Virginia_2026_PA_Audit.docx",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "Non-preferred - exception process for stable patients"
        }
      },
      "WV-MAC-PALMETTO": {
        "Neurotoxins": {
          "state": "WV",
          "payerName": "Palmetto GBA",
          "payerType": "Medicare MAC",
          "lob": "Part B",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "Per LCD DL39909; Mandatory HIT-6/MIDAS Scores",
          "step1Duration": "Adequate trial",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Every 12 weeks max",
          "contraBypass": "Yes",
          "goldCardAvail": "N/A (Federal)",
          "goldCardThresh": null,
          "policyId": "LCD DL39909",
          "sourceDoc": "Q1-2026-Policy-Refresh",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        }
      },
      "OR-COM-CAMBIA": {
        "CGRP mAbs (SC)": {
          "state": "OR",
          "payerName": "Regence BlueCross BlueShield",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "≥8 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Monthly supply",
          "contraBypass": "Yes - CV; teratogenic",
          "goldCardAvail": "No (HB 3134 stripped Gold Card)",
          "goldCardThresh": null,
          "policyId": "Regence Policy",
          "sourceDoc": "Oregon_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Gepants (Acute)": {
          "state": "OR",
          "payerName": "Regence BlueCross BlueShield",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 triptans",
          "step1Duration": "Trial required",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Plan dependent",
          "contraBypass": "Yes - CV contraindication",
          "goldCardAvail": "No (HB 3134 stripped Gold Card)",
          "goldCardThresh": null,
          "policyId": "Regence Policy",
          "sourceDoc": "Oregon_2026_PA_Audit",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Neurotoxins": {
          "state": "OR",
          "payerName": "Regence BlueCross BlueShield",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "Trial required",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "155 units/12 weeks",
          "contraBypass": "Yes",
          "goldCardAvail": "No (HB 3134 stripped Gold Card)",
          "goldCardThresh": null,
          "policyId": "Regence Medical Policy",
          "sourceDoc": "Oregon_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        }
      },
      "OR-COM-PROVIDENCE": {
        "CGRP mAbs (SC)": {
          "state": "OR",
          "payerName": "Providence Health Plan Oregon",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral classes",
          "step1Duration": "Documented",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Aimovig/Ajovy Tier 3/4; Emgality often NON-PREFERRED (Tier 4 or Non-Formulary); ⚠️ Part B Step Therapy may require Part D drug first",
          "contraBypass": "Yes - teratogenic; cognitive; respiratory",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "Providence Policy",
          "sourceDoc": "Oregon_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "OR-COM-MODA": {
        "CGRP mAbs (SC)": {
          "state": "OR",
          "payerName": "Moda Health",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "Trial required",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Monthly supply",
          "contraBypass": "Yes",
          "goldCardAvail": "No (HB 3134)",
          "goldCardThresh": null,
          "policyId": "Moda Policy",
          "sourceDoc": "Oregon_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Gepants (Acute)": {
          "state": "OR",
          "payerName": "Moda Health Oregon",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 triptans",
          "step1Duration": "Documented (claims lookback)",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "⚠️ PBM automation (Navitus) = hard stops; ST flag = auto-reject if no triptan claims 180-365d; 'New Member Trap' = preemptive PA mandatory",
          "contraBypass": "Yes - CV contraindication",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "Moda Formulary",
          "sourceDoc": "Oregon_2026_PA_Audit",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "CGRP mAbs (IV)": {
          "state": "OR",
          "payerName": "Moda Health Oregon",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (IV)",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventives + objective measures (HIT-6)",
          "step1Duration": "Documented",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Medical benefit; HIT-6 scores emphasized",
          "contraBypass": "Yes - teratogenic; cognitive; respiratory",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "Moda Policy",
          "sourceDoc": "Oregon_2026_PA_Audit",
          "denialCode": "DENY-STEP-003",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "IA-COM-WELLBCBS": {
        "CGRP mAbs (SC)": {
          "state": "IA",
          "payerName": "Wellmark BCBS",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "Yes, requires trial and failure of BOTH preferred products (Ajovy and Emgality) prior to approval.",
          "step1Duration": "Trial required",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Monthly supply",
          "contraBypass": "Yes - CV; teratogenic",
          "goldCardAvail": "No state mandate",
          "goldCardThresh": null,
          "policyId": "Wellmark Policy",
          "sourceDoc": "Q1-2026-Policy-Refresh",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Gepants (Acute)": {
          "state": "IA",
          "payerName": "Wellmark BCBS",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 triptans",
          "step1Duration": "Trial required",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Plan dependent",
          "contraBypass": "Yes - CV contraindication",
          "goldCardAvail": "No state mandate",
          "goldCardThresh": null,
          "policyId": "Wellmark Policy",
          "sourceDoc": "Iowa_2026_PA_Audit_Report",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Neurotoxins": {
          "state": "IA",
          "payerName": "Wellmark BCBS",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "Trial required",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "155 units/12 weeks",
          "contraBypass": "Yes",
          "goldCardAvail": "No state mandate",
          "goldCardThresh": null,
          "policyId": "Wellmark Medical Policy",
          "sourceDoc": "Iowa_2026_PA_Audit_Report",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        }
      },
      "IA-COM-UHC": {
        "CGRP mAbs (SC)": {
          "state": "IA",
          "payerName": "UnitedHealthcare Iowa",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral classes",
          "step1Duration": "Documented",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "⚠️ HF 303: 48hr urgent / 10 days standard; 24hr receipt mandate; 'Advance Notification' protocols",
          "contraBypass": "Yes - teratogenic; cognitive; respiratory",
          "goldCardAvail": "✓ National + HF 303",
          "goldCardThresh": "92%",
          "policyId": "UHC Policy",
          "sourceDoc": "Iowa_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Gepants (Acute)": {
          "state": "IA",
          "payerName": "UnitedHealthcare",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 triptans; Smart Edits",
          "step1Duration": "30 days each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Nurtec 8/30d; Ubrelvy 16/30d",
          "contraBypass": "Yes - CV contraindication",
          "goldCardAvail": "Yes (UHC National)",
          "goldCardThresh": "≥92% approval rate",
          "policyId": "UHC Policy",
          "sourceDoc": "Iowa_2026_PA_Audit_Report",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Gepants (Preventive)": {
          "state": "IA",
          "payerName": "UHC Iowa",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Preventive)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "Standard CGRP criteria",
          "step1Duration": "≥8 weeks",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "15-16 tabs/30 days",
          "contraBypass": "Yes - standard",
          "goldCardAvail": "No",
          "goldCardThresh": null,
          "policyId": null,
          "sourceDoc": "Iowa_2026_PA_Audit.md",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "Preventive dosing logic applied"
        }
      },
      "IA-COM-AETNA": {
        "CGRP mAbs (SC)": {
          "state": "IA",
          "payerName": "Aetna",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral classes",
          "step1Duration": "Trial required",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Monthly supply",
          "contraBypass": "Yes",
          "goldCardAvail": "No state mandate",
          "goldCardThresh": null,
          "policyId": "Aetna Policy",
          "sourceDoc": "Iowa_2026_PA_Audit_Report",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "IA-MCD-IAHHS": {
        "CGRP mAbs (SC)": {
          "state": "IA",
          "payerName": "Iowa Medicaid (HHS)",
          "payerType": "Medicaid FFS",
          "lob": "Medicaid",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "Per IA PDL - Form 470-5554",
          "step1Duration": "Trial required",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "PDL limits",
          "contraBypass": "Yes",
          "goldCardAvail": "No",
          "goldCardThresh": null,
          "policyId": "Iowa HHS PDL",
          "sourceDoc": "Iowa_2026_PA_Audit_Report",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "NE-COM-NEBBCBS": {
        "CGRP mAbs (SC)": {
          "state": "NE",
          "payerName": "Blue Cross Blue Shield Nebraska",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥1 oral preventive class,≥3 months",
          "step1Duration": null,
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Monthly supply; Aimovig/Emgality preferred; Ajovy non-preferred",
          "contraBypass": "Yes - Topiramate bypass (kidney stones, cognitive job)",
          "goldCardAvail": "No state mandate",
          "goldCardThresh": null,
          "policyId": "BCBSNE M.14/M.29/M.30",
          "sourceDoc": "Nebraska_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Neurotoxins": {
          "state": "NE",
          "payerName": "Blue Cross Blue Shield Nebraska",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes; ICHD-3 definition (≥15 days/mo + ≥8 migrainous)",
          "step1Duration": "Trial required",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "155 units/12 weeks",
          "contraBypass": "Yes - cite AHS 2021 for dual therapy",
          "goldCardAvail": "No state mandate",
          "goldCardThresh": null,
          "policyId": "BCBSNE Medical Policy",
          "sourceDoc": "Nebraska_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        }
      },
      "NE-COM-UHC": {
        "CGRP mAbs (SC)": {
          "state": "NE",
          "payerName": "UnitedHealthcare",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral classes",
          "step1Duration": "Trial required",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Aimovig/Emgality preferred",
          "contraBypass": "Yes",
          "goldCardAvail": "Yes (UHC National)",
          "goldCardThresh": "≥92% approval rate",
          "policyId": "UHC CGRP Policy",
          "sourceDoc": "Nebraska_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Gepants (Preventive)": {
          "state": "NE",
          "payerName": "UHC NE",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Preventive)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "Standard criteria",
          "step1Duration": null,
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "30 tabs/30 days",
          "contraBypass": "Yes - standard",
          "goldCardAvail": "No",
          "goldCardThresh": null,
          "policyId": null,
          "sourceDoc": "Nebraska_2026_PA_Audit.md",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "Expanded indications noted"
        }
      },
      "NE-MCD-HERITAGE": {
        "CGRP mAbs (SC)": {
          "state": "NE",
          "payerName": "Nebraska Medicaid (Heritage Health)",
          "payerType": "Medicaid",
          "lob": "Medicaid",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥1 traditional preventive (Beta-blocker/TCA/Anticonvulsant)",
          "step1Duration": ">3 months",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Uniform PDL; step therapy required",
          "contraBypass": "Yes - teratogenic; cognitive; respiratory",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "NE Uniform PDL",
          "sourceDoc": "Nebraska_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Neurotoxins": {
          "state": "NE",
          "payerName": "Nebraska Heritage Health (Medicaid)",
          "payerType": "Medicaid MCO",
          "lob": "Medicaid",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 different oral preventive classes; ICHD-3 criteria",
          "step1Duration": "Trial required",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "155 units/12 weeks; Dual therapy cite AHS 2021",
          "contraBypass": "Yes - SNAP-25/CGRP distinct mechanisms",
          "goldCardAvail": "No",
          "goldCardThresh": null,
          "policyId": "Heritage Health Medical",
          "sourceDoc": "Nebraska_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        },
        "Gepants (Acute)": {
          "state": "NE",
          "payerName": "Nebraska Medicaid (Heritage Health)",
          "payerType": "Medicaid",
          "lob": "Medicaid",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 preferred triptans (Sumatriptan/Rizatriptan)",
          "step1Duration": "Documented",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "QL: 16/30d (Ubrelvy), 15/30d (Nurtec); Tier 1 PA Required; uniform across MCOs",
          "contraBypass": "Yes - CV contraindication",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "NE Uniform PDL",
          "sourceDoc": "Nebraska_2026_PA_Audit",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "CGRP mAbs (IV)": {
          "state": "NE",
          "payerName": "Nebraska Medicaid (Heritage Health)",
          "payerType": "Medicaid",
          "lob": "Medicaid",
          "drugClass": "CGRP mAbs (IV)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral classes + ≥1 SC CGRP mAb (Aimovig/Emgality)",
          "step1Duration": "Documented failures",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "⚠️ Step 2/3 agent - requires SC CGRP failure before IV access",
          "contraBypass": "Yes - SC CGRP failure + oral contraindications",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "NE Uniform PDL",
          "sourceDoc": "Nebraska_2026_PA_Audit",
          "denialCode": "DENY-QL-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "WY-COM-WYBCBS": {
        "CGRP mAbs (SC)": {
          "state": "WY",
          "payerName": "Blue Cross Blue Shield Wyoming",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral classes",
          "step1Duration": "Trial required",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Aimovig/Emgality preferred",
          "contraBypass": "Yes",
          "goldCardAvail": "Yes (W.S. § 26-55-112 - Medical Only)",
          "goldCardThresh": "Drugs excluded from Gold Card",
          "policyId": "BCBSWY Policy",
          "sourceDoc": "Wyoming_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Gepants (Acute)": {
          "state": "WY",
          "payerName": "Blue Cross Blue Shield Wyoming",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "Explicit addition of \"triptan combination agents\" to the step requirement for acute migraine therapy",
          "step1Duration": "Trial required",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Plan dependent",
          "contraBypass": "Yes - CV contraindication",
          "goldCardAvail": "Yes (W.S. § 26-55-112 - Medical Only)",
          "goldCardThresh": "Drugs excluded",
          "policyId": "BCBSWY Policy",
          "sourceDoc": "Q1-2026-Policy-Refresh",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Neurotoxins": {
          "state": "WY",
          "payerName": "Blue Cross Blue Shield Wyoming",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral classes",
          "step1Duration": "Trial required",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "155 units/12 weeks",
          "contraBypass": "Yes",
          "goldCardAvail": "Yes (W.S. § 26-55-112 - Medical Only)",
          "goldCardThresh": "90% approval rate",
          "policyId": "BCBSWY Medical Policy",
          "sourceDoc": "Wyoming_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        }
      },
      "WY-COM-UHC": {
        "CGRP mAbs (SC)": {
          "state": "WY",
          "payerName": "UnitedHealthcare Wyoming",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "≥8 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "'Advanced Notification' PA-lite even for Gold Card exempt services; portal Gold Card status tracking",
          "contraBypass": "Yes - teratogenic; cognitive; respiratory",
          "goldCardAvail": "✓ National + W.S. § 26-55-112",
          "goldCardThresh": "90%/92%",
          "policyId": "UHC Policy",
          "sourceDoc": "Wyoming_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Gepants (Acute)": {
          "state": "WY",
          "payerName": "UnitedHealthcare",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥1-2 triptans (plan dependent)",
          "step1Duration": "Trial required",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Plan dependent",
          "contraBypass": "Yes - CV contraindication",
          "goldCardAvail": "Yes (UHC National + State)",
          "goldCardThresh": "Medical Only",
          "policyId": "UHC Policy",
          "sourceDoc": "Wyoming_2026_PA_Audit",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Neurotoxins": {
          "state": "WY",
          "payerName": "UnitedHealthcare",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral classes",
          "step1Duration": "Trial required",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "155 units/12 weeks",
          "contraBypass": "Yes",
          "goldCardAvail": "Yes (UHC National + State)",
          "goldCardThresh": "Medical Only",
          "policyId": "UHC Medical Policy",
          "sourceDoc": "Wyoming_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        }
      },
      "WY-MCD-WYMEDICAID": {
        "CGRP mAbs (SC)": {
          "state": "WY",
          "payerName": "Wyoming Medicaid",
          "payerType": "Medicaid FFS",
          "lob": "Medicaid",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 triptans acute + oral preventives",
          "step1Duration": "Trial required",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Aimovig/Emgality preferred",
          "contraBypass": "Yes",
          "goldCardAvail": "Excluded from Gold Card",
          "goldCardThresh": null,
          "policyId": "WY Medicaid PDL",
          "sourceDoc": "Wyoming_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Neurotoxins": {
          "state": "WY",
          "payerName": "Wyoming Medicaid",
          "payerType": "Medicaid FFS",
          "lob": "Medicaid",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "Requires a 12-week trial of a CGRP or gepant prior to Botox approval",
          "step1Duration": "Requires a 12-week trial of a CGRP or gepant prior to Botox approval",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "155 units/12 weeks",
          "contraBypass": "Yes",
          "goldCardAvail": "Excluded from Gold Card",
          "goldCardThresh": null,
          "policyId": "WY Medicaid Medical",
          "sourceDoc": "Q1-2026-Policy-Refresh",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        }
      },
      "WY-MAC-NORIDIAN": {
        "Neurotoxins": {
          "state": "WY",
          "payerName": "Noridian Healthcare Solutions",
          "payerType": "Medicare MAC",
          "lob": "Part B",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥3 oral classes per LCD DL39909",
          "step1Duration": "Adequate trial",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "155 units/12 weeks",
          "contraBypass": "Yes",
          "goldCardAvail": "N/A (Federal)",
          "goldCardThresh": null,
          "policyId": "LCD DL39909",
          "sourceDoc": "Wyoming_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        }
      },
      "IN-COM-ELEV": {
        "CGRP mAbs (SC)": {
          "state": "IN",
          "payerName": "Anthem (Elevance)",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "≥8 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Monthly supply",
          "contraBypass": "Yes - CV; teratogenic",
          "goldCardAvail": "No state mandate",
          "goldCardThresh": null,
          "policyId": "Anthem IN Policy",
          "sourceDoc": "Indiana_2026_PA_Audit_Strategy",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": "8.0",
          "episodicNotes": "Anthem: Episodic (<8d) = 1 oral class; Episodic (≥8d) = same as chronic (1 oral class). More lenient than most payers for episodic."
        },
        "Neurotoxins": {
          "state": "IN",
          "payerName": "Anthem (Elevance)",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "Trial required",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "155 units/12 weeks",
          "contraBypass": "Yes",
          "goldCardAvail": "No state mandate",
          "goldCardThresh": null,
          "policyId": "Anthem Medical Policy",
          "sourceDoc": "Indiana_2026_PA_Audit_Strategy",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        }
      },
      "IN-COM-UHC": {
        "CGRP mAbs (SC)": {
          "state": "IN",
          "payerName": "UnitedHealthcare Indiana",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "No",
          "step1Req": "UHC March 1, 2026 pharmacy update: Ajovy (fremanezumab) pediatric criteria added; Nurtec ODT and Qulipta removed as Ajovy step therapy options (no longer required before Ajovy); Emgality 100mg concomitant CGRP language updated.",
          "step1Duration": "Documented",
          "step2Req": "UHC March 1, 2026 pharmacy update: Ajovy (fremanezumab) pediatric criteria added; Nurtec ODT and Qulipta removed as Ajovy step therapy options (no longer required before Ajovy); Emgality 100mg concomitant CGRP language updated.",
          "step2Duration": null,
          "quantityLimit": "⚠️ SB 480: 24hr urgent / 48hr non-urgent; peer review same specialty; National Gold Card 92%",
          "contraBypass": "Yes - teratogenic; cognitive; respiratory; stability",
          "goldCardAvail": "✓ National Gold Card",
          "goldCardThresh": "92%",
          "policyId": "UHC Policy",
          "sourceDoc": "Q1-2026-Policy-Refresh",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "IN-MCD-CARESOURCE": {
        "CGRP mAbs (SC)": {
          "state": "IN",
          "payerName": "CareSource Indiana",
          "payerType": "Medicaid MCO",
          "lob": "Medicaid",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "Per FSSA PDL",
          "step1Duration": "Trial required",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "PDL limits",
          "contraBypass": "Yes",
          "goldCardAvail": "No",
          "goldCardThresh": null,
          "policyId": "CareSource IN Policy",
          "sourceDoc": "Indiana_2026_PA_Audit_Strategy",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "WI-COM-UHC": {
        "CGRP mAbs (SC)": {
          "state": "WI",
          "payerName": "UnitedHealthcare",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral classes",
          "step1Duration": "Trial required",
          "step2Req": "Nurtec ODT and Qulipta removed as therapeutic options for Ajovy",
          "step2Duration": null,
          "quantityLimit": "Aimovig/Emgality preferred",
          "contraBypass": "bypass for pediatric patients added",
          "goldCardAvail": "Yes (UHC National)",
          "goldCardThresh": "≥92% approval rate",
          "policyId": "UHC CGRP Policy",
          "sourceDoc": "Q1-2026-Policy-Refresh",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "WI-COM-ELEV": {
        "CGRP mAbs (SC)": {
          "state": "WI",
          "payerName": "Anthem (Elevance)",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "Trial required",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Monthly supply",
          "contraBypass": "Yes",
          "goldCardAvail": "No state mandate",
          "goldCardThresh": null,
          "policyId": "Anthem WI Policy",
          "sourceDoc": "Wisconsin_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": "8.0",
          "episodicNotes": "Anthem: Episodic (<8d) = 1 oral class; Episodic (≥8d) = same as chronic (1 oral class). More lenient than most payers for episodic."
        }
      },
      "MO-COM-ELEV": {
        "CGRP mAbs (SC)": {
          "state": "MO",
          "payerName": "Anthem (Elevance)",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "Trial required",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Monthly supply",
          "contraBypass": "Yes - CV; teratogenic",
          "goldCardAvail": "No state mandate",
          "goldCardThresh": null,
          "policyId": "Anthem MO Policy",
          "sourceDoc": "Missouri_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": "8.0",
          "episodicNotes": "Anthem: Episodic (<8d) = 1 oral class; Episodic (≥8d) = same as chronic (1 oral class). More lenient than most payers for episodic."
        }
      },
      "MO-COM-UHC": {
        "CGRP mAbs (SC)": {
          "state": "MO",
          "payerName": "UnitedHealthcare Missouri",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "Added bypass for pediatric patients; Removed Nurtec and Qulipta as options for Ajovy",
          "step1Duration": "Documented",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "PREFERRED: Aimovig, Emgality; ⚠️ Ajovy = excluded; MOH must be ruled out; ⚠️ SSM Health exit Jan 2026 = RSMo § 354.612 Continuity 90 days",
          "contraBypass": "Added bypass for pediatric patients; Removed Nurtec and Qulipta as options for Ajovy",
          "goldCardAvail": "✓ HB 618 + National",
          "goldCardThresh": "90%",
          "policyId": "UHC Policy",
          "sourceDoc": "Q1-2026-Policy-Refresh",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Neurotoxins": {
          "state": "MO",
          "payerName": "UnitedHealthcare Missouri",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral classes",
          "step1Duration": "Documented",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "15/8/4 criteria; ⚠️ MOH must be explicitly ruled out; washout may be required",
          "contraBypass": "Yes - oral contraindications",
          "goldCardAvail": "✓ HB 618 (CPT 64615)",
          "goldCardThresh": "90%",
          "policyId": "UHC Botox Policy",
          "sourceDoc": "Missouri_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        },
        "Gepants (Preventive)": {
          "state": "MO",
          "payerName": "UHC Missouri",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Preventive)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "Per Medicaid clinical pearl guidance",
          "step1Duration": "≥8 weeks",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "16 tabs/30 days",
          "contraBypass": "Yes - standard",
          "goldCardAvail": "No",
          "goldCardThresh": null,
          "policyId": null,
          "sourceDoc": "Missouri_2026_PA_Audit.md",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "Often restricted; clinical pearl for denials"
        }
      },
      "LA-COM-LABLUE": {
        "CGRP mAbs (SC)": {
          "state": "LA",
          "payerName": "Louisiana Blue (BCBSLA)",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "Trial required",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Monthly supply; Dominant payer (66%)",
          "contraBypass": "Yes - CV; teratogenic",
          "goldCardAvail": "No state mandate",
          "goldCardThresh": null,
          "policyId": "BCBSLA Policy",
          "sourceDoc": "Louisiana_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "LA-COM-UHC": {
        "CGRP mAbs (SC)": {
          "state": "LA",
          "payerName": "UnitedHealthcare Louisiana",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral classes (national UHC criteria)",
          "step1Duration": "Documented",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Strict national UM via Optum; ⚠️ Request Gold Card status for CPT 64615/J3032 under Act 432",
          "contraBypass": "Yes - teratogenic; cognitive; respiratory",
          "goldCardAvail": "✓ National Gold Card + Act 432 medical",
          "goldCardThresh": "92% / 90%",
          "policyId": "UHC Policy",
          "sourceDoc": "Louisiana_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Gepants (Preventive)": {
          "state": "LA",
          "payerName": "UHC Louisiana",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Preventive)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "Triptan history + oral preventive failure",
          "step1Duration": "≥8 weeks",
          "step2Req": "Preferred CGRP mAb trial",
          "step2Duration": null,
          "quantityLimit": "16 tabs/30 days",
          "contraBypass": "Yes - vasoconstrictor contraindication",
          "goldCardAvail": "No",
          "goldCardThresh": null,
          "policyId": null,
          "sourceDoc": "Louisiana_2026_PA_Audit.md",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "Requires triptan AND preventive history"
        }
      },
      "SC-COM-SCARBCBS": {
        "CGRP mAbs (SC)": {
          "state": "SC",
          "payerName": "Blue Cross Blue Shield SC",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "Trial required",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Monthly supply; Dominant payer (59%)",
          "contraBypass": "Yes - CV; teratogenic",
          "goldCardAvail": "No state mandate",
          "goldCardThresh": null,
          "policyId": "BCBSSC Policy",
          "sourceDoc": "South_Carolina_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "SC-COM-UHC": {
        "CGRP mAbs (SC)": {
          "state": "SC",
          "payerName": "UnitedHealthcare",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral classes",
          "step1Duration": "Trial required",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Aimovig/Emgality preferred",
          "contraBypass": "Yes",
          "goldCardAvail": "Yes (UHC National)",
          "goldCardThresh": "≥92% approval rate",
          "policyId": "UHC CGRP Policy",
          "sourceDoc": "South_Carolina_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Gepants (Preventive)": {
          "state": "SC",
          "payerName": "UHC South Carolina",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Preventive)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "Standard CGRP criteria",
          "step1Duration": "≥8 weeks",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "16 tabs/30 days (vs 8 acute)",
          "contraBypass": "Yes - standard",
          "goldCardAvail": "No",
          "goldCardThresh": null,
          "policyId": null,
          "sourceDoc": "South_Carolina_2026_PA_Audit.md",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "Quantity limit triggers preventive policy review"
        }
      },
      "SC-MAC-PALMETTO": {
        "Neurotoxins": {
          "state": "SC",
          "payerName": "Palmetto GBA",
          "payerType": "Medicare MAC",
          "lob": "Part B",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "Per LCD DL39909",
          "step1Duration": "Adequate trial",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "155 units/12 weeks; G43.7xx codes only",
          "contraBypass": "Allowed with documentation of \"further reduction\" in MMD",
          "goldCardAvail": "N/A (Federal)",
          "goldCardThresh": null,
          "policyId": "LCD DL39909",
          "sourceDoc": "Q1-2026-Policy-Refresh",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        }
      },
      "TN-COM-TENBCBS": {
        "CGRP mAbs (SC)": {
          "state": "TN",
          "payerName": "Blue Cross Blue Shield Tennessee",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "Trial required",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Monthly supply",
          "contraBypass": "Yes - CV; teratogenic",
          "goldCardAvail": "No state mandate",
          "goldCardThresh": null,
          "policyId": "BCBST Policy",
          "sourceDoc": "Tennessee_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "TN-COM-UHC": {
        "CGRP mAbs (SC)": {
          "state": "TN",
          "payerName": "UnitedHealthcare",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral classes",
          "step1Duration": "Trial required",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Aimovig/Emgality preferred",
          "contraBypass": "Yes",
          "goldCardAvail": "Yes (UHC National)",
          "goldCardThresh": "≥92% approval rate",
          "policyId": "UHC CGRP Policy",
          "sourceDoc": "Tennessee_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Gepants (Preventive)": {
          "state": "TN",
          "payerName": "UHC TN",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Preventive)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventives",
          "step1Duration": "≥8 weeks",
          "step2Req": "Injectable CGRP failure (some plans)",
          "step2Duration": "Varies",
          "quantityLimit": "30 tabs/30 days",
          "contraBypass": "Yes - needle phobia; injection site reactions",
          "goldCardAvail": "No",
          "goldCardThresh": null,
          "policyId": null,
          "sourceDoc": "Tennessee_2026_PA_Audit.md",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "Varies by plan - some post-mAb positioning"
        }
      },
      "TN-MAC-PALMETTO": {
        "Neurotoxins": {
          "state": "TN",
          "payerName": "Palmetto GBA",
          "payerType": "Medicare MAC",
          "lob": "Part B",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "Per LCD DL39909",
          "step1Duration": "Adequate trial",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "155 units/12 weeks; G43.7xx codes only",
          "contraBypass": "Yes",
          "goldCardAvail": "N/A (Federal)",
          "goldCardThresh": null,
          "policyId": "LCD DL39909",
          "sourceDoc": "Tennessee_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        }
      },
      "VA-COM-ELEV": {
        "CGRP mAbs (SC)": {
          "state": "VA",
          "payerName": "Anthem HealthKeepers",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 different oral generic classes: Antidepressants (amitriptyline/venlafaxine); Beta-blockers (propranolol/metoprolol/atenolol); Antiepileptics (topiramate/valproate); ACE/ARBs",
          "step1Duration": "≥1 MONTH each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "PREFERRED: Aimovig, Ajovy, Emgality; NON-PREFERRED: Vyepti (requires fail 2 SC mAbs first)",
          "contraBypass": "Yes - Disqualify beta-blockers (asthma J45.909/bradycardia/hypotension/depression); Disqualify TCAs (BPH N40.1/Beers Criteria elderly/obesity); Disqualify topiramate (kidney stones N20.0/cognitive hazard); Disqualify valproate (teratogenic - women of childbearing potential)",
          "goldCardAvail": "HB 2099 - Data Collection 2026",
          "goldCardThresh": "90% threshold",
          "policyId": "VABCBS-CD-096511-25",
          "sourceDoc": "Virginia_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": "8.0",
          "episodicNotes": "Anthem: Episodic (<8d) = 1 oral class; Episodic (≥8d) = same as chronic (1 oral class). More lenient than most payers for episodic."
        },
        "Gepants (Acute)": {
          "state": "VA",
          "payerName": "Anthem HealthKeepers",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "\"≥2 preferred generic triptans; hard edit at POS - if pharmacy system doesn't see 2 triptan claims, Nurtec/Ubrelvy rejects\",Claims history required,N/A",
          "step1Duration": null,
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "PREFERRED: Nurtec ODT, Ubrelvy; NON-PREFERRED: Reyvow, Zavzpret",
          "contraBypass": "Yes - CV bypass (HTN I10, IHD I25.9, arrhythmia I49.9) = 'Contraindication to vasoconstrictive agents'; Serotonin syndrome bypass if on SSRI/SNRI; Gastroparesis bypass for Zavzpret",
          "goldCardAvail": "HB 2099 - Data Collection 2026",
          "goldCardThresh": "90% threshold (exemptions Jan 2027)",
          "policyId": "VABCBS-CD-096511-25",
          "sourceDoc": "Virginia_2026_PA_Audit",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Neurotoxins": {
          "state": "VA",
          "payerName": "Anthem HealthKeepers",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes,≥1 month each",
          "step1Duration": null,
          "step2Req": null,
          "step2Duration": "Chronic Migraine (≥15 HA days",
          "quantityLimit": " ≥8 migrainous); ⚠️ HIT-6/MIDAS documentation for LCD compliance",
          "contraBypass": "Yes - oral preventive contraindications",
          "goldCardAvail": "HB 2099 - Data Collection 2026",
          "goldCardThresh": "90% threshold",
          "policyId": "Anthem Botox Policy",
          "sourceDoc": "Virginia_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        },
        "CGRP mAbs (IV)": {
          "state": "VA",
          "payerName": "Anthem HealthKeepers",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (IV)",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "≥1 month each",
          "step2Req": "Must fail 2 preferred SC CGRPs (Aimovig/Ajovy/Emgality)",
          "step2Duration": "Documented failure",
          "quantityLimit": "NON-PREFERRED; bypass via: 100% bioavailability argument (status migrainosus); Physical/cognitive limitation preventing self-injection (arthritis/tremor/cognitive impairment)",
          "contraBypass": "Yes - inability to self-inject; bioavailability requirement",
          "goldCardAvail": "HB 2099 - Data Collection 2026",
          "goldCardThresh": "90% threshold",
          "policyId": "Anthem Vyepti Policy",
          "sourceDoc": "Virginia_2026_PA_Audit",
          "denialCode": "DENY-QL-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "VA-COM-UHC": {
        "CGRP mAbs (SC)": {
          "state": "VA",
          "payerName": "UnitedHealthcare Virginia",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "⚠️ ≥2 MONTHS each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "PREFERRED: Aimovig, Emgality; NON-PREFERRED/EXCLUDED: Ajovy (2026); Reauth requires quantitative response ('Reduction in MHD from 12 to 5' - not vague 'improvement')",
          "contraBypass": "Yes - teratogenic; CV contraindication; documented intolerance",
          "goldCardAvail": "UHC National Gold Card ACTIVE",
          "goldCardThresh": "92% threshold",
          "policyId": "UHC CGRP Policy",
          "sourceDoc": "Virginia_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Gepants (Acute)": {
          "state": "VA",
          "payerName": "UnitedHealthcare Virginia",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 triptans",
          "step1Duration": "Documented failure",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Standard criteria; ⚠️ Nurtec ODT denied if patient on CYP3A4 inhibitor (itraconazole/clarithromycin) - switch to Ubrelvy 50mg or justify interaction managed",
          "contraBypass": "Yes - CV contraindication; CYP3A4 interaction management",
          "goldCardAvail": "UHC National Gold Card ACTIVE",
          "goldCardThresh": "92% threshold",
          "policyId": "UHC Gepant Policy",
          "sourceDoc": "Virginia_2026_PA_Audit",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "CGRP mAbs (IV)": {
          "state": "VA",
          "payerName": "UnitedHealthcare Virginia",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (IV)",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "≥2 months each",
          "step2Req": "⚠️ DOUBLE STEP: Must fail 2 self-injectable CGRPs (Aimovig/Ajovy/Emgality) for 3 months EACH = 6+ month delay minimum",
          "step2Duration": "≥3 months per SC CGRP",
          "quantityLimit": "STRICT; bypass via: Absorption issues (bariatric surgery/malabsorption); Severe injection site reaction to SC CGRP (large induration >5cm persisting 7+ days) - re-challenging poses anaphylaxis risk",
          "contraBypass": "Yes - absorption issues; hypersensitivity reaction to SC CGRP",
          "goldCardAvail": "UHC National Gold Card",
          "goldCardThresh": "92% threshold",
          "policyId": "UHC Vyepti Policy",
          "sourceDoc": "Virginia_2026_PA_Audit",
          "denialCode": "DENY-QL-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Neurotoxins": {
          "state": "VA",
          "payerName": "UnitedHealthcare Virginia",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "≥2 months each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Chronic Migraine (≥15 days); strict criteria; quantitative response required for reauth",
          "contraBypass": "Yes - oral preventive contraindications",
          "goldCardAvail": "UHC National Gold Card",
          "goldCardThresh": "92% threshold for CPT 64615",
          "policyId": "UHC Botox Policy",
          "sourceDoc": "Virginia_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        }
      },
      "VA-MAC-PALMETTO": {
        "Neurotoxins": {
          "state": "VA",
          "payerName": "Palmetto GBA",
          "payerType": "Medicare MAC",
          "lob": "Part B",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "Palmetto GBA finalized updated botulinum toxin LCD effective February 22, 2026. New chronic migraine coverage criteria: (a) headaches ≥15 days/month, ≥8 migraine days/month, ≥4 hours/migraine day, present ≥3 months; (b) trial and inadequate response to a 2-month trial of at least 1 agent in any 2 of: antidepressant class, beta-blocker class, or antiepileptic class; (c) enhanced documentation requirements at baseline and following each injection session. Palmetto GBA was one of 5 MACs (with CGS, ",
          "step1Duration": "Palmetto GBA finalized updated botulinum toxin LCD effective February 22, 2026. New chronic migraine coverage criteria: (a) headaches ≥15 days/month, ≥8 migraine days/month, ≥4 hours/migraine day, present ≥3 months; (b) trial and inadequate response to a 2-month trial of at least 1 agent in any 2 of: antidepressant class, beta-blocker class, or antiepileptic class; (c) enhanced documentation requirements at baseline and following each injection session. Palmetto GBA was one of 5 MACs (with CGS, ",
          "step2Req": "Palmetto GBA finalized updated botulinum toxin LCD effective February 22, 2026. New chronic migraine coverage criteria: (a) headaches ≥15 days/month, ≥8 migraine days/month, ≥4 hours/migraine day, present ≥3 months; (b) trial and inadequate response to a 2-month trial of at least 1 agent in any 2 of: antidepressant class, beta-blocker class, or antiepileptic class; (c) enhanced documentation requirements at baseline and following each injection session. Palmetto GBA was one of 5 MACs (with CGS, ",
          "step2Duration": null,
          "quantityLimit": "155 units/12 weeks; G43.7xx codes only",
          "contraBypass": "Yes",
          "goldCardAvail": "N/A (Federal)",
          "goldCardThresh": null,
          "policyId": "LCD DL39909",
          "sourceDoc": "Q1-2026-Policy-Refresh",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        }
      },
      "OH-COM-ELEV": {
        "CGRP mAbs (SC)": {
          "state": "OH",
          "payerName": "Anthem Blue Cross Blue Shield Ohio",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥1 oral preventive class (sometimes only 1 - UNIQUE vs 2-3 for others, varies by employer group)",
          "step1Duration": "≥2 months",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Emgality/Aimovig generally preferred; Ajovy often Non-Preferred",
          "contraBypass": "Yes - teratogenic; CV contraindication; documented intolerance",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "Anthem Medical Policy",
          "sourceDoc": "Ohio_2026_PA_Audit_Strategy",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": "8.0",
          "episodicNotes": "Anthem: Episodic (<8d) = 1 oral class; Episodic (≥8d) = same as chronic (1 oral class). More lenient than most payers for episodic."
        },
        "Gepants (Acute)": {
          "state": "OH",
          "payerName": "Anthem Blue Cross Blue Shield Ohio",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 preferred triptans (Sumatriptan, Rizatriptan, Eletriptan, Naratriptan, Zolmitriptan); ⚠️ CarelonRx AUTO-DENIES if no triptan claims in 180 days",
          "step1Duration": "Electronic step therapy checks claims history",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Nurtec/Ubrelvy Tier 2/3 depending on plan (Essential vs National); Zavzpret NON-PREFERRED requires triptan + oral gepant failure",
          "contraBypass": "Yes - CV contraindication",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "Anthem/CarelonRx Formulary",
          "sourceDoc": "Ohio_2026_PA_Audit_Strategy",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Gepants (Preventive)": {
          "state": "OH",
          "payerName": "Anthem Blue Cross Blue Shield Ohio",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Preventive)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥1 oral preventive class",
          "step1Duration": "≥2 months",
          "step2Req": "Requires step through preferred injectable CGRP (Emgality/Aimovig) first",
          "step2Duration": "Documented failure",
          "quantityLimit": "To get Qulipta as first-line CGRP must document 'Needle Phobia' (F40.231) or 'Inability to Self-Inject'",
          "contraBypass": "Yes - needle phobia F40.231; physical inability to self-administer",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "Anthem Qulipta Policy",
          "sourceDoc": "Ohio_2026_PA_Audit_Strategy",
          "denialCode": "DENY-QL-001",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": "8.0",
          "episodicNotes": "Anthem: Episodic (<8d) = 1 oral class; Episodic (≥8d) = same as chronic (1 oral class). More lenient than most payers for episodic."
        },
        "Neurotoxins": {
          "state": "OH",
          "payerName": "Anthem Blue Cross Blue Shield Ohio",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "≥2 months each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Chronic Migraine (≥15 HA days/mo)",
          "contraBypass": "Yes - oral preventive contraindications",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "Anthem Medical Policy",
          "sourceDoc": "Ohio_2026_PA_Audit_Strategy",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        },
        "CGRP mAbs (IV)": {
          "state": "OH",
          "payerName": "Anthem Blue Cross Blue Shield Ohio",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (IV)",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "≥2 months each",
          "step2Req": "Must fail oral prophylaxis AND self-injected CGRP mAbs (Aimovig/Emgality/Ajovy) OR valid contraindication to self-injection",
          "step2Duration": "Documented",
          "quantityLimit": "J3032; must document: 'Patient has failed Emgality due to lack of efficacy (MHD unchanged after 3 months) and is unable to self-administer due to [arthritis/tremor/anxiety]'",
          "contraBypass": "Yes - needle phobia; arthritis; tremor; anxiety",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "Anthem Vyepti Policy",
          "sourceDoc": "Ohio_2026_PA_Audit_Strategy",
          "denialCode": "DENY-QL-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "OH-COM-UHC": {
        "CGRP mAbs (SC)": {
          "state": "OH",
          "payerName": "UnitedHealthcare Ohio",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥1-2 oral preventive classes",
          "step1Duration": "≥8 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Aimovig/Emgality standard preferred; Ajovy Tier 3/4 Non-Preferred requires preferred agent failure; Gold Card opportunity eliminates PA workflow",
          "contraBypass": "Yes - teratogenic; CV contraindication",
          "goldCardAvail": "Yes - ACTIVE (Oct 2024)",
          "goldCardThresh": "92% approval rate",
          "policyId": "UHC CGRP Policy",
          "sourceDoc": "Ohio_2026_PA_Audit_Strategy",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Gepants (Acute)": {
          "state": "OH",
          "payerName": "UnitedHealthcare Ohio",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 triptans",
          "step1Duration": "Documented failure",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Ubrelvy often preferred over Nurtec for ACUTE; Nurtec preferred for preventive use (episodic); Zavzpret requires triptan + Ubrelvy/Nurtec failure",
          "contraBypass": "Yes - CV contraindication",
          "goldCardAvail": "Yes - ACTIVE (Oct 2024)",
          "goldCardThresh": "92% approval rate",
          "policyId": "UHC/OptumRx Formulary",
          "sourceDoc": "Ohio_2026_PA_Audit_Strategy",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Neurotoxins": {
          "state": "OH",
          "payerName": "UnitedHealthcare Ohio",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "≥8 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "⚠️ STRICT enforcement of '15 headache days' rule - documentation must be explicit; standard Chronic Migraine criteria",
          "contraBypass": "Yes - oral preventive contraindications",
          "goldCardAvail": "Yes - ACTIVE (Oct 2024)",
          "goldCardThresh": "92% approval rate on CPT 64615",
          "policyId": "UHC Botox Policy",
          "sourceDoc": "Ohio_2026_PA_Audit_Strategy",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        },
        "CGRP mAbs (IV)": {
          "state": "OH",
          "payerName": "UnitedHealthcare Ohio",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (IV)",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "≥8 weeks each",
          "step2Req": "Must fail SC CGRP OR document inability to self-inject",
          "step2Duration": "Documented",
          "quantityLimit": "J3032; ⚠️ Site of Care review - HOPD DENIED unless medical necessity: 'difficult venous access requiring ultrasound guidance' OR 'history of anaphylaxis requiring hospital-grade resuscitation'; redirect to home infusion/office",
          "contraBypass": "Yes - needle phobia; difficult venous access; anaphylaxis history",
          "goldCardAvail": "Yes - ACTIVE (Oct 2024)",
          "goldCardThresh": "92% approval rate on J3032",
          "policyId": "UHC Vyepti Policy",
          "sourceDoc": "Ohio_2026_PA_Audit_Strategy",
          "denialCode": "DENY-GOLD-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "OH-MCD-CARESOURCE": {
        "CGRP mAbs (SC)": {
          "state": "OH",
          "payerName": "CareSource Ohio",
          "payerType": "Medicaid MCO",
          "lob": "Medicaid Pharmacy",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥3 oral preventive classes per UPDL (pharmacy carved to Gainwell)",
          "step1Duration": "≥30 days each per UPDL",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "UPDL criteria apply; pharmacy managed by Gainwell",
          "contraBypass": "Yes - per UPDL contraindication criteria",
          "goldCardAvail": "HB 130 (Pending)",
          "goldCardThresh": null,
          "policyId": "Ohio UPDL (via Gainwell)",
          "sourceDoc": "Ohio_2026_PA_Audit_Strategy",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Neurotoxins": {
          "state": "OH",
          "payerName": "CareSource Ohio",
          "payerType": "Medicaid MCO",
          "lob": "Medical Benefit",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes (NOTE: Medical benefit = 2 classes vs pharmacy UPDL = 3 classes)",
          "step1Duration": "≥2 months each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "J0585; Chronic Migraine (≥15 HA days/mo, ≥8 migraine days) for >3 months; managed by CareSource Medical Mgmt NOT Gainwell; headache diary/summary required",
          "contraBypass": "Yes - oral preventive contraindications",
          "goldCardAvail": "HB 130 (Pending)",
          "goldCardThresh": null,
          "policyId": "CareSource Medical Policy",
          "sourceDoc": "Ohio_2026_PA_Audit_Strategy",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        },
        "Gepants (Acute)": {
          "state": "OH",
          "payerName": "CareSource Ohio",
          "payerType": "Medicaid MCO",
          "lob": "Medicaid Pharmacy",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 preferred triptans per UPDL (pharmacy carved to Gainwell)",
          "step1Duration": "Per UPDL",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "UPDL quantity limits apply; pharmacy managed by Gainwell NOT CareSource",
          "contraBypass": "Yes - CV contraindication per UPDL",
          "goldCardAvail": "HB 130 (Pending)",
          "goldCardThresh": null,
          "policyId": "Ohio UPDL (via Gainwell)",
          "sourceDoc": "Ohio_2026_PA_Audit_Strategy",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "MD-COM-CAREFIRST": {
        "CGRP mAbs (SC)": {
          "state": "MD",
          "payerName": "CareFirst BlueCross BlueShield",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥1 oral preventive class (Beta-blocker/Antiepileptic/Antidepressant)",
          "step1Duration": "≥8 weeks",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "PREFERRED: Aimovig, Emgality; NON-PREFERRED: Ajovy (requires Aimovig OR Emgality failure or hypersensitivity); Vyepti = Medical Benefit",
          "contraBypass": "Yes - teratogenic; cognitive; respiratory",
          "goldCardAvail": "⚠️ Study mandated",
          "goldCardThresh": null,
          "policyId": "CareFirst Policy",
          "sourceDoc": "Maryland_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Gepants (Acute)": {
          "state": "MD",
          "payerName": "CareFirst BlueCross BlueShield",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 preferred triptans (Sumatriptan/Rizatriptan/Eletriptan)",
          "step1Duration": "Documented",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Non-Preferred Tier 3; ⚠️ Zavzpret requires oral gepant failure OR severe nausea/gastroparesis",
          "contraBypass": "Yes - CV contraindication; Serotonin Syndrome risk",
          "goldCardAvail": "⚠️ Study mandated",
          "goldCardThresh": null,
          "policyId": "CareFirst Formulary",
          "sourceDoc": "Maryland_2026_PA_Audit",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Neurotoxins": {
          "state": "MD",
          "payerName": "CareFirst BlueCross BlueShield",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "⚠️ ≥3 DIFFERENT drug classes (higher than CGRP requirement)",
          "step1Duration": "≥2 months each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Policy 11.01.003; Chronic Migraine (15/8 ICHD-3); reauth requires ≥50% reduction OR ≥7 fewer days; biosimilar pressure (Dysport lacks CM indication = appeal)",
          "contraBypass": "Yes - oral contraindications",
          "goldCardAvail": "⚠️ Study mandated",
          "goldCardThresh": null,
          "policyId": "CareFirst 11.01.003",
          "sourceDoc": "Maryland_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        },
        "Gepants (Preventive)": {
          "state": "MD",
          "payerName": "CareFirst",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Preventive)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "≥8 weeks",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "16 tabs/30 days",
          "contraBypass": "Yes - standard",
          "goldCardAvail": "No",
          "goldCardThresh": null,
          "policyId": null,
          "sourceDoc": "Maryland_2026_PA_Audit.docx",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "Non-Preferred status"
        }
      },
      "MD-COM-UHC": {
        "CGRP mAbs (SC)": {
          "state": "MD",
          "payerName": "UnitedHealthcare Maryland",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 different oral classes",
          "step1Duration": "≥2 months each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "PREFERRED: Aimovig, Emgality 120mg; EXCLUDED: Ajovy; ⚠️ HB 820 AI Transparency - query compliance in appeals",
          "contraBypass": "Yes - teratogenic; cognitive; respiratory",
          "goldCardAvail": "✓ National voluntary",
          "goldCardThresh": "92%",
          "policyId": "UHC CGRP Policy",
          "sourceDoc": "Maryland_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Gepants (Acute)": {
          "state": "MD",
          "payerName": "UnitedHealthcare Maryland",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 triptans",
          "step1Duration": "Documented",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "QL Nurtec 16/30d; Ubrelvy 16/30d; high utilization flagged for MOH review",
          "contraBypass": "Yes - CV contraindication",
          "goldCardAvail": "✓ National voluntary",
          "goldCardThresh": "92%",
          "policyId": "UHC Formulary",
          "sourceDoc": "Maryland_2026_PA_Audit",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "CGRP mAbs (IV)": {
          "state": "MD",
          "payerName": "UnitedHealthcare Maryland",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (IV)",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "⚠️ THIRD-LINE: Oral preventives + 2 SC CGRPs (Aimovig AND Emgality)",
          "step1Duration": "Documented failures",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Medical Necessity; needle phobia/compliance bypass",
          "contraBypass": "Yes - needle phobia; inability to self-inject",
          "goldCardAvail": "✓ National voluntary",
          "goldCardThresh": "92%",
          "policyId": "UHC Vyepti Policy",
          "sourceDoc": "Q1-2026-Policy-Refresh",
          "denialCode": "DENY-QL-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "Medication will not be used in combination with another biologic CGRP antagonist or inhibitor used for preventive treatment."
        },
        "Neurotoxins": {
          "state": "MD",
          "payerName": "UnitedHealthcare Maryland",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "⚠️ Often requires CGRP failure FIRST; Dual Therapy requires 'partial response' + 'significant disability',Documented",
          "step1Duration": null,
          "step2Req": null,
          "step2Duration": "Site of Care redirection (office OK",
          "quantityLimit": " Vyepti may redirect to home infusion)",
          "contraBypass": "Yes - CGRP contraindication",
          "goldCardAvail": "✓ National voluntary",
          "goldCardThresh": "92%",
          "policyId": "UHC Botox Policy",
          "sourceDoc": "Maryland_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        }
      },
      "MD-MAC-NOVITAS": {
        "Neurotoxins": {
          "state": "MD",
          "payerName": "Novitas Solutions",
          "payerType": "Medicare MAC",
          "lob": "Part B",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "Per LCD DL39909",
          "step1Duration": "Adequate trial",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "155 units/12 weeks",
          "contraBypass": "Yes",
          "goldCardAvail": "N/A (Federal)",
          "goldCardThresh": null,
          "policyId": "LCD DL39909",
          "sourceDoc": "Q1-2026-Policy-Refresh",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series.",
          "siteOfCare": "Mandatory Prior Authorization required for administration in ASC and HOPD settings (WISeR model demonstration)"
        }
      },
      "CO-COM-UHC": {
        "CGRP mAbs (SC)": {
          "state": "CO",
          "payerName": "UnitedHealthcare / RMHP",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral classes (Antidepressants/Beta-blockers/Anticonvulsants)",
          "step1Duration": "≥6 weeks each (shorter than Medicaid 8 weeks)",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "PREFERRED: Aimovig, Emgality; NON-PREFERRED: Ajovy (Step 2 - requires failure of Aimovig OR Emgality first); 'attestation' of oral failures acceptable but chart notes must back it up for retrospective audit",
          "contraBypass": "Yes - teratogenic; CV contraindication; documented intolerance; cite 'Failed Step 1 Preferred CGRP due to severe constipation/injection site reaction'",
          "goldCardAvail": "HB 24-1149 ACTIVE",
          "goldCardThresh": "90%",
          "policyId": "UHC CGRP Step Therapy",
          "sourceDoc": "Colorado_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Gepants (Acute)": {
          "state": "CO",
          "payerName": "UnitedHealthcare / RMHP",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥1 triptan (loosened from previous 2 triptan requirement); automated system often looks for 2 distinct claims - explicitly state 'Failure of Sumatriptan due to lack of efficacy'",
          "step1Duration": "Documented failure",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "QL 8-12 tablets/30 days; to override: 'Acute Medication Overuse is not present' OR 'Headache frequency requires >12 doses but total monthly intake monitored to prevent rebound'",
          "contraBypass": "Yes - CV Contraindication",
          "goldCardAvail": "⚠️ HB 24-1149 ACTIVE but 90% threshold (dispute if 80-89%)",
          "goldCardThresh": "90% (exceeds statutory 80%)",
          "policyId": "UHC Gepant Policy",
          "sourceDoc": "Colorado_2026_PA_Audit",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Neurotoxins": {
          "state": "CO",
          "payerName": "UnitedHealthcare / RMHP",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral classes; ⚠️ prior CGRP mAb trial can count as one 'failed class' (path: Oral→CGRP→Botox)",
          "step1Duration": "Documented failure",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Chronic Migraine (≥15 days) NON-NEGOTIABLE - Episodic (<15 days) = automatic denial; ⚠️ 'Dual Therapy Block' - concurrent Botox+CGRP requires 'Partial Response' documentation + 'Clinical Rationale' for adding second modality",
          "contraBypass": "Yes - oral preventive contraindications; document 'refractory chronic migraine with partial response to CGRP blockade'",
          "goldCardAvail": "HB 24-1149 ACTIVE",
          "goldCardThresh": "90%",
          "policyId": "UHC Botox Policy",
          "sourceDoc": "Colorado_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        }
      },
      "CO-COM-ELEV": {
        "CGRP mAbs (SC)": {
          "state": "CO",
          "payerName": "Anthem BCBS Colorado",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥1 oral preventive class (MORE LENIENT than 2-class requirement of others)",
          "step1Duration": "≥2 months",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "PREFERRED: Emgality, Ajovy (National list); NON-PREFERRED/PA: Aimovig; ⚠️ Vyepti requires 2 oral agents + 1 preferred SC CGRP failure; Vyepti bypass: 'Physical disability preventing self-administration' / 'Severe needle phobia with vasovagal syncope history' / 'Cognitive impairment requiring provider-administered therapy'",
          "contraBypass": "Yes - teratogenic; CV contraindication; self-injection inability",
          "goldCardAvail": "HB 24-1149 ACTIVE - tracking",
          "goldCardThresh": "Tracking",
          "policyId": "Anthem CGRP Policy",
          "sourceDoc": "Colorado_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": "8.0",
          "episodicNotes": "Anthem: Episodic (<8d) = 1 oral class; Episodic (≥8d) = same as chronic (1 oral class). More lenient than most payers for episodic."
        },
        "Gepants (Acute)": {
          "state": "CO",
          "payerName": "Anthem BCBS Colorado",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 prescription triptans (Eletriptan, Rizatriptan, Sumatriptan, Naratriptan preferred)",
          "step1Duration": "Documented failure",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "NON-PREFERRED: Nurtec, Ubrelvy; ⚠️ 'Patient prefers not to take triptans' = IMMEDIATE DENIAL; must state specific contraindication: 'Contraindicated due to risk of serotonin syndrome with concurrent SSRI' or 'Vascular risk factors'",
          "contraBypass": "Yes - CV contraindication; serotonin syndrome risk with SSRI; documented specific contraindication required",
          "goldCardAvail": "HB 24-1149 ACTIVE - tracking",
          "goldCardThresh": "Tracking approval rates",
          "policyId": "Anthem Select Drug List",
          "sourceDoc": "Colorado_2026_PA_Audit",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Neurotoxins": {
          "state": "CO",
          "payerName": "Anthem BCBS Colorado",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes; ⚠️ specifically names TOPIRAMATE or DIVALPROEX as required step (amitriptyline + propranolol may NOT be enough - they want anticonvulsant failure)",
          "step1Duration": "Documented failure",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Chronic Migraine; ⚠️ TERATOGENICITY ARGUMENT = silver bullet: 'Contraindication to anticonvulsants due to reproductive potential' removes anticonvulsant hurdle",
          "contraBypass": "Yes - teratogenic contraindication to Topiramate/Valproate; nephrolithiasis (kidney stones) contraindication to Topiramate; bradycardia contraindication to beta-blockers",
          "goldCardAvail": "HB 24-1149 ACTIVE - tracking",
          "goldCardThresh": "Tracking",
          "policyId": "Anthem Botox Policy",
          "sourceDoc": "Colorado_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        }
      },
      "CO-COM-KAISER": {
        "CGRP mAbs (SC)": {
          "state": "CO",
          "payerName": "Kaiser Permanente Colorado",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "Multiple oral agents + non-pharmacological interventions (biofeedback, relaxation training)",
          "step1Duration": "Documented failure of each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "PREFERRED: Topiramate, Propranolol, Amitriptyline; RESTRICTED: Aimovig, Emgality, Ajovy; ⚠️ External specialist strategy: cite Colorado Network Adequacy laws if Kaiser internal providers failed to manage migraine - patient has right to effective treatment from specialist",
          "contraBypass": "Yes - functional impairment; cite AHS guidelines for refractory migraine; Network Adequacy laws for external prescriptions",
          "goldCardAvail": "Internal Protocol - exemptions rare",
          "goldCardThresh": "Internal",
          "policyId": "Kaiser Internal Protocol",
          "sourceDoc": "Colorado_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Gepants (Acute)": {
          "state": "CO",
          "payerName": "Kaiser Permanente Colorado",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 generic triptans (Sumatriptan, Rizatriptan)",
          "step1Duration": "Documented failure",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "RESTRICTED: Nurtec/Ubrelvy strictly non-formulary or high-tier requiring 'Non-Formulary' approval; ⚠️ Only reliable bypass = SAFETY arguments ('Risk of Stroke' / 'Severe Adverse Event' / 'Serotonin syndrome risk with antidepressants') - 'better efficacy' arguments rarely work",
          "contraBypass": "Yes - vascular contraindication; serotonin syndrome risk; safety-based arguments only",
          "goldCardAvail": "Internal Protocol - exemptions rare",
          "goldCardThresh": "Internal",
          "policyId": "Kaiser Formulary",
          "sourceDoc": "Colorado_2026_PA_Audit",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "CO-MAC-NORIDIAN": {
        "Neurotoxins": {
          "state": "CO",
          "payerName": "Noridian Healthcare Solutions",
          "payerType": "Medicare MAC",
          "lob": "Part B",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "Per LCD DL39909",
          "step1Duration": "Adequate trial",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "155 units/12 weeks",
          "contraBypass": "Yes",
          "goldCardAvail": "N/A (Federal)",
          "goldCardThresh": null,
          "policyId": "LCD DL39909",
          "sourceDoc": "Q1-2026-Policy-Refresh",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "episodic migraine strictly excluded; must document >15 days/month"
        }
      },
      "UT-COM-UHC": {
        "CGRP mAbs (SC)": {
          "state": "UT",
          "payerName": "UnitedHealthcare",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral classes",
          "step1Duration": "Trial required",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Aimovig/Emgality preferred",
          "contraBypass": "Added bypass for pediatric patients; Removed Nurtec and Qulipta as options for Ajovy",
          "goldCardAvail": "Yes (UHC National)",
          "goldCardThresh": "≥92% approval rate",
          "policyId": "UHC CGRP Policy",
          "sourceDoc": "Q1-2026-Policy-Refresh",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "UT-COM-REGENCE": {
        "CGRP mAbs (SC)": {
          "state": "UT",
          "payerName": "Regence BCBS Utah",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 classes",
          "step1Duration": "≥2 months each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Policy dru540; 6mo initial auth; reauth requires ≥50% reduction documentation",
          "contraBypass": "Yes - teratogenic; cognitive; respiratory",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "Regence dru540",
          "sourceDoc": "Utah_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "CGRP mAbs (IV)": {
          "state": "UT",
          "payerName": "Regence BCBS Utah",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (IV)",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "⚠️ DOUBLE STEP: oral failures + 1-2 SC CGRP failures",
          "step1Duration": "Documented",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Medical benefit; Site of Care dru408 (home infusion/office preferred over HOPD)",
          "contraBypass": "Yes - needle phobia; dexterity; severe infusion reaction history",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "Regence dru540/dru408",
          "sourceDoc": "Utah_2026_PA_Audit",
          "denialCode": "DENY-QL-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "UT-MCD-MOLINA": {
        "CGRP mAbs (SC)": {
          "state": "UT",
          "payerName": "Molina Healthcare Utah",
          "payerType": "Medicaid MCO",
          "lob": "Medicaid",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "Required to align with Utah Medicaid state PDL effective January 1, 2026; 90-day transition period",
          "step1Duration": "Trial required",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "PDL limits; Dominant Medicaid payer (42.5%)",
          "contraBypass": "Yes",
          "goldCardAvail": "No",
          "goldCardThresh": null,
          "policyId": "Molina UT Policy",
          "sourceDoc": "Q1-2026-Policy-Refresh",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "UT-MAC-NORIDIAN": {
        "Neurotoxins": {
          "state": "UT",
          "payerName": "Noridian Healthcare Solutions",
          "payerType": "Medicare MAC",
          "lob": "Part B",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "Noridian finalized updated botulinum toxin LCD effective February 22, 2026. New chronic migraine criteria: (a) headaches ≥15 days/month, ≥8 migraine days/month, ≥4 hours/migraine day, present ≥3 months; (b) trial and inadequate response to a 2-month trial of at least 1 agent in any 2 of: antidepressant class, beta-blocker class, or antiepileptic class; (c) enhanced documentation requirements at baseline and following each injection session.",
          "step1Duration": "Noridian finalized updated botulinum toxin LCD effective February 22, 2026. New chronic migraine criteria: (a) headaches ≥15 days/month, ≥8 migraine days/month, ≥4 hours/migraine day, present ≥3 months; (b) trial and inadequate response to a 2-month trial of at least 1 agent in any 2 of: antidepressant class, beta-blocker class, or antiepileptic class; (c) enhanced documentation requirements at baseline and following each injection session.",
          "step2Req": "Noridian finalized updated botulinum toxin LCD effective February 22, 2026. New chronic migraine criteria: (a) headaches ≥15 days/month, ≥8 migraine days/month, ≥4 hours/migraine day, present ≥3 months; (b) trial and inadequate response to a 2-month trial of at least 1 agent in any 2 of: antidepressant class, beta-blocker class, or antiepileptic class; (c) enhanced documentation requirements at baseline and following each injection session.",
          "step2Duration": null,
          "quantityLimit": "155 units/12 weeks",
          "contraBypass": "Yes",
          "goldCardAvail": "N/A (Federal)",
          "goldCardThresh": null,
          "policyId": "LCD DL39909",
          "sourceDoc": "Q1-2026-Policy-Refresh",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        }
      },
      "MS-COM-UHC": {
        "CGRP mAbs (SC)": {
          "state": "MS",
          "payerName": "UnitedHealthcare",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral classes",
          "step1Duration": "Trial required",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Aimovig/Emgality preferred",
          "contraBypass": "Yes",
          "goldCardAvail": "Yes (UHC National)",
          "goldCardThresh": "≥92% approval rate",
          "policyId": "UHC CGRP Policy",
          "sourceDoc": "Mississippi_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Gepants (Preventive)": {
          "state": "MS",
          "payerName": "UHC Mississippi",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Preventive)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "≥8 weeks each",
          "step2Req": "Fail preferred injectable CGRP (Aimovig/Emgality)",
          "step2Duration": null,
          "quantityLimit": "16 tabs/30 days",
          "contraBypass": "Yes - needle phobia",
          "goldCardAvail": "No",
          "goldCardThresh": null,
          "policyId": null,
          "sourceDoc": "Mississippi_2026_PA_Audit.md",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "Double step required; no dual CGRP therapy"
        }
      },
      "MS-MCD-MSDOM": {
        "CGRP mAbs (SC)": {
          "state": "MS",
          "payerName": "Mississippi Medicaid (DOM)",
          "payerType": "Medicaid FFS",
          "lob": "Medicaid",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "Per MS DOM PA Criteria (Form CGRP-08_25_2025)",
          "step1Duration": "Trial required",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "PDL limits",
          "contraBypass": "Yes",
          "goldCardAvail": "No",
          "goldCardThresh": null,
          "policyId": "MS DOM CGRP Criteria",
          "sourceDoc": "Mississippi_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "MS-MAC-NOVITAS": {
        "Neurotoxins": {
          "state": "MS",
          "payerName": "Novitas Solutions",
          "payerType": "Medicare MAC",
          "lob": "Part B",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "Per LCD DL39909",
          "step1Duration": "Adequate trial",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "155 units/12 weeks",
          "contraBypass": "Yes",
          "goldCardAvail": "N/A (Federal)",
          "goldCardThresh": null,
          "policyId": "LCD DL39909",
          "sourceDoc": "Mississippi_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        }
      },
      "WA-COM-REGENCE": {
        "CGRP mAbs (SC)": {
          "state": "WA",
          "payerName": "Regence BlueShield WA",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "Documented failure",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "PREFERRED: Aimovig, Emgality; NON-PREFERRED: Ajovy, Vyepti; Vyepti requires failure of ALL viable self-injectable CGRPs before approval",
          "contraBypass": "Yes - teratogenic; CV contraindication; documented intolerance",
          "goldCardAvail": "NO - SB 5395 FAILED",
          "goldCardThresh": null,
          "policyId": "Regence dru540",
          "sourceDoc": "Washington_State_PA_Audit_2026",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Gepants (Acute)": {
          "state": "WA",
          "payerName": "Regence BlueShield WA",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 triptans; ⚠️ Failure defined as 'adequate trial = treatment of at least 3 migraine episodes' - single failed dose NOT valid; notes must read: 'Patient treated 3 separate attacks with Sumatriptan 100mg without relief'",
          "step1Duration": "≥3 attacks treated per triptan",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Nurtec ODT/Ubrelvy require 2 triptan failures",
          "contraBypass": "Yes - CV contraindication",
          "goldCardAvail": "NO - SB 5395 FAILED",
          "goldCardThresh": null,
          "policyId": "Regence dru540",
          "sourceDoc": "Washington_State_PA_Audit_2026",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Neurotoxins": {
          "state": "WA",
          "payerName": "Regence BlueShield WA",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "Documented failure",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Chronic Migraine (>15 days); standard criteria",
          "contraBypass": "Yes - oral preventive contraindications",
          "goldCardAvail": "NO - SB 5395 FAILED",
          "goldCardThresh": null,
          "policyId": "Regence dru006",
          "sourceDoc": "Washington_State_PA_Audit_2026",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        },
        "CGRP mAbs (IV)": {
          "state": "WA",
          "payerName": "Regence BlueShield WA",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (IV)",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "Documented failure",
          "step2Req": "Failure of ALL viable self-injectable CGRPs",
          "step2Duration": "Documented failure",
          "quantityLimit": "J3032; ⚠️ SITE OF CARE RESTRICTION - HOPD NON-PREFERRED; refer to home infusion or freestanding infusion clinic; HOPD only if: 'History of difficult IV access requiring ultrasound guidance' OR 'History of severe anaphylaxis requiring hospital-grade resuscitation capabilities'",
          "contraBypass": "Yes - inability to self-inject; anaphylaxis history",
          "goldCardAvail": "NO - SB 5395 FAILED",
          "goldCardThresh": null,
          "policyId": "Regence dru006/dru540",
          "sourceDoc": "Washington_State_PA_Audit_2026",
          "denialCode": "DENY-QL-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "WA-COM-UHC": {
        "CGRP mAbs (SC)": {
          "state": "WA",
          "payerName": "UnitedHealthcare",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral classes",
          "step1Duration": "Trial required",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Aimovig/Emgality preferred",
          "contraBypass": "Yes",
          "goldCardAvail": "Yes (UHC National)",
          "goldCardThresh": "≥92% approval rate",
          "policyId": "UHC CGRP Policy",
          "sourceDoc": "Washington_State_PA_Audit_2026",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "WA-MCD-MOLINA": {
        "CGRP mAbs (SC)": {
          "state": "WA",
          "payerName": "Molina Healthcare WA",
          "payerType": "Medicaid MCO",
          "lob": "Medicaid",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "Per WA HCA PDL",
          "step1Duration": "Trial required",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "PDL limits",
          "contraBypass": "Yes",
          "goldCardAvail": "No",
          "goldCardThresh": null,
          "policyId": "Molina WA Policy",
          "sourceDoc": "Washington_State_PA_Audit_2026",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "WA-MAC-NORIDIAN": {
        "Neurotoxins": {
          "state": "WA",
          "payerName": "Noridian Healthcare Solutions",
          "payerType": "Medicare MAC",
          "lob": "Part B",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "'Traditional methods of treatments have been tried and proven unsuccessful' - vague but audit defense = document ≥2 distinct oral preventive classes",
          "step1Duration": "Documented in medical record",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "LCD L35172; ⚠️ Chronic Migraine ONLY (G43.701/G43.709/G43.711/G43.719) - Episodic = 'cosmetic/investigational' = RIGID DENIAL; Diagnostic threshold: >15 HA days/mo with 4+ hours/day; ⚠️ 12-WEEK FREQUENCY STRICT - claims at 10-11 weeks = automated denial unless 'wearing off' substantiated with peer-reviewed literature (difficult); 155-200 units recognized; >200u = manual medical review",
          "contraBypass": "Yes - documented oral failures with adverse events",
          "goldCardAvail": "No - Federal Medicare",
          "goldCardThresh": null,
          "policyId": "LCD L35172 / Article A57186",
          "sourceDoc": "Washington_State_PA_Audit_2026",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        }
      },
      "AK-COM-PREMBC": {
        "Gepants (Acute)": {
          "state": "AK",
          "payerName": "Premera Blue Cross",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 triptans",
          "step1Duration": "Trial required",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Tier 3; HCLV exclusions may apply",
          "contraBypass": "Yes - CV contraindication",
          "goldCardAvail": "No state mandate",
          "goldCardThresh": null,
          "policyId": "Premera Policy 5.01.584",
          "sourceDoc": "Alaska_2026_PA_Audit",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "CGRP mAbs (SC)": {
          "state": "AK",
          "payerName": "Premera Blue Cross",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 categories traditional prophylaxis",
          "step1Duration": "Trial required",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Monthly supply; Site of Service review for Vyepti",
          "contraBypass": "Yes - CV; teratogenic",
          "goldCardAvail": "No state mandate",
          "goldCardThresh": null,
          "policyId": "Premera Policy 5.01.584",
          "sourceDoc": "Alaska_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Neurotoxins": {
          "state": "AK",
          "payerName": "Premera Blue Cross",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥3 categories prophylaxis (stricter)",
          "step1Duration": "8 weeks each for two different prophylactic categories",
          "step2Req": null,
          "step2Duration": "8 weeks each for two different prophylactic categories",
          "quantityLimit": "155 units/12 weeks; 50% reduction for renewal",
          "contraBypass": "Yes",
          "goldCardAvail": "No state mandate",
          "goldCardThresh": null,
          "policyId": "Premera Medical Policy",
          "sourceDoc": "Q1-2026-Policy-Refresh",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        }
      },
      "AK-COM-MODA": {
        "CGRP mAbs (SC)": {
          "state": "AK",
          "payerName": "Moda Health Alaska",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral medications",
          "step1Duration": "≥8 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Vyepti initial auth limited to 6 months (shorter than standard 12); renewal requires documented MMD reduction; 300mg max q3mo",
          "contraBypass": "Yes - teratogenic; cognitive; respiratory",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "Moda Formulary",
          "sourceDoc": "Alaska_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "AK-MCD-DENALI": {
        "Gepants (Acute)": {
          "state": "AK",
          "payerName": "Alaska Medicaid (DenaliCare)",
          "payerType": "Medicaid",
          "lob": "Medicaid",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "⚠️ 'Double Step Trap': 2 different triptans + 1 prophylactic",
          "step1Duration": "≥2 months prophylactic",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Unusually high bar for acute meds; MOH must be ruled out; implies prevention must be optimized first",
          "contraBypass": "Yes - CV contraindication",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "AK PDL",
          "sourceDoc": "Alaska_2026_PA_Audit",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "CGRP mAbs (SC)": {
          "state": "AK",
          "payerName": "Alaska Medicaid (DenaliCare)",
          "payerType": "Medicaid",
          "lob": "Medicaid",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 prophylactic classes (Beta-blocker + Antiepileptic)",
          "step1Duration": "≥2 months each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Episodic (4-14 days) or Chronic (15+); ⚠️ Concurrent CGRP use prohibited without refractory appeal",
          "contraBypass": "Yes - teratogenic; cognitive; respiratory",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "AK PDL",
          "sourceDoc": "Alaska_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Neurotoxins": {
          "state": "AK",
          "payerName": "Alaska Medicaid (DenaliCare)",
          "payerType": "Medicaid FFS",
          "lob": "Medicaid",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 classes; Neurologist only",
          "step1Duration": "Trial required",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "155 units/12 weeks",
          "contraBypass": "Yes",
          "goldCardAvail": "No",
          "goldCardThresh": null,
          "policyId": "DenaliCare Medical Policy",
          "sourceDoc": "Alaska_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        }
      },
      "AK-COM-UHC": {
        "CGRP mAbs (SC)": {
          "state": "AK",
          "payerName": "UnitedHealthcare",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 prophylactic therapies",
          "step1Duration": "≥2 months each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Aimovig/Emgality preferred",
          "contraBypass": "Yes",
          "goldCardAvail": "Yes (UHC National)",
          "goldCardThresh": "≥90% approval rate",
          "policyId": "UHC CGRP Policy",
          "sourceDoc": "Alaska_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Gepants (Acute)": {
          "state": "AK",
          "payerName": "UnitedHealthcare Alaska",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 triptans with history of 3+ migraine episodes",
          "step1Duration": "Documented",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Zavzpret excluded unless oral gepants fail (severe nausea/vomiting)",
          "contraBypass": "Yes - CV contraindication",
          "goldCardAvail": "✓ National Gold Card",
          "goldCardThresh": "92%",
          "policyId": "UHC Policy",
          "sourceDoc": "Alaska_2026_PA_Audit",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "AK-MAC-NORIDIAN": {
        "Neurotoxins": {
          "state": "AK",
          "payerName": "Noridian Healthcare Solutions",
          "payerType": "Medicare MAC",
          "lob": "Part B",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "Per LCD L35172; JW modifier for waste",
          "step1Duration": "Failure of at least one agent in any two specified classes (antidepressants, beta blockers, CCBs, antiepileptics) for a minimum of two months each.",
          "step2Req": null,
          "step2Duration": "Failure of at least one agent in any two specified classes (antidepressants, beta blockers, CCBs, antiepileptics) for a minimum of two months each.",
          "quantityLimit": "155 units/12 weeks",
          "contraBypass": "Yes",
          "goldCardAvail": "N/A (Federal)",
          "goldCardThresh": null,
          "policyId": "LCD L35172",
          "sourceDoc": "Q1-2026-Policy-Refresh",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        }
      },
      "AR-COM-BCBSAR": {
        "CGRP mAbs (SC)": {
          "state": "AR",
          "payerName": "Blue Cross Blue Shield Arkansas",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "Trial required",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Monthly supply",
          "contraBypass": "Yes - CV; teratogenic",
          "goldCardAvail": "No state mandate",
          "goldCardThresh": null,
          "policyId": "BCBSAR Policy",
          "sourceDoc": "Arkansas_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Gepants (Acute)": {
          "state": "AR",
          "payerName": "Blue Cross Blue Shield Arkansas",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 triptans",
          "step1Duration": "Trial required",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Plan dependent",
          "contraBypass": "Yes - CV contraindication",
          "goldCardAvail": "No state mandate",
          "goldCardThresh": null,
          "policyId": "BCBSAR Policy",
          "sourceDoc": "Arkansas_2026_PA_Audit",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Neurotoxins": {
          "state": "AR",
          "payerName": "Blue Cross Blue Shield Arkansas",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "Trial required",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "155 units/12 weeks",
          "contraBypass": "Yes",
          "goldCardAvail": "No state mandate",
          "goldCardThresh": null,
          "policyId": "BCBSAR Medical Policy",
          "sourceDoc": "Arkansas_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        }
      },
      "AR-COM-UHC": {
        "CGRP mAbs (SC)": {
          "state": "AR",
          "payerName": "UnitedHealthcare",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral classes",
          "step1Duration": "Trial required",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Aimovig/Emgality preferred",
          "contraBypass": "Yes",
          "goldCardAvail": "Yes (UHC National)",
          "goldCardThresh": "≥92% approval rate",
          "policyId": "UHC CGRP Policy",
          "sourceDoc": "Arkansas_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "AR-MCD-ARDHS": {
        "CGRP mAbs (SC)": {
          "state": "AR",
          "payerName": "Arkansas Medicaid (DHS)",
          "payerType": "Medicaid FFS",
          "lob": "Medicaid",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "Per AR DHS PDL",
          "step1Duration": "Trial required",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "PDL limits",
          "contraBypass": "Yes",
          "goldCardAvail": "No",
          "goldCardThresh": null,
          "policyId": "AR DHS PDL",
          "sourceDoc": "Arkansas_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "AR-MAC-NOVITAS": {
        "Neurotoxins": {
          "state": "AR",
          "payerName": "Novitas Solutions",
          "payerType": "Medicare MAC",
          "lob": "Part B",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "Per LCD DL39909",
          "step1Duration": "Adequate trial",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "155 units/12 weeks",
          "contraBypass": "Yes",
          "goldCardAvail": "N/A (Federal)",
          "goldCardThresh": null,
          "policyId": "LCD DL39909",
          "sourceDoc": "Arkansas_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        }
      },
      "HI-COM-HMSA": {
        "CGRP mAbs (SC)": {
          "state": "HI",
          "payerName": "Hawaii Medical Service Association (HMSA)",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "≥8 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "CVS Caremark managed; SB 226 Stability Mandate = continuity if stable on therapy",
          "contraBypass": "Yes - teratogenic; cognitive (Topiramate); nephrolithiasis",
          "goldCardAvail": "⚠️ Voluntary pilots",
          "goldCardThresh": null,
          "policyId": "HMSA Formulary",
          "sourceDoc": "Hawaii_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "HMSA: Commercial = 1 oral class for episodic CGRP vs 2 for chronic. QUEST Medicaid = 2 classes for both."
        },
        "Gepants (Acute)": {
          "state": "HI",
          "payerName": "Hawaii Medical Service Association (HMSA)",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 distinct triptans (Sumatriptan/Rizatriptan/Eletriptan/Zolmitriptan)",
          "step1Duration": "Documented",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Tier 3 Non-Preferred Brand; QUEST = PA required; ⚠️ SB 226 override available",
          "contraBypass": "Yes - CV contraindication; gastroparesis; reproductive status",
          "goldCardAvail": "⚠️ Voluntary pilots",
          "goldCardThresh": null,
          "policyId": "HMSA Formulary",
          "sourceDoc": "Hawaii_2026_PA_Audit",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Neurotoxins": {
          "state": "HI",
          "payerName": "Hawaii Medical Service Association (HMSA)",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "Trial required",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "155 units/12 weeks",
          "contraBypass": "Yes",
          "goldCardAvail": "No state mandate",
          "goldCardThresh": null,
          "policyId": "HMSA Medical Policy",
          "sourceDoc": "Q1-2026-Policy-Refresh",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "Updated medical policy notes for Botulinum Toxins (Revision 6.04)"
        },
        "Gepants (Preventive)": {
          "state": "HI",
          "payerName": "HMSA",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Preventive)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "Fail preferred agent (Aimovig)",
          "step1Duration": null,
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "30 tabs/30 days",
          "contraBypass": "Yes - adverse effect from preferred",
          "goldCardAvail": "No",
          "goldCardThresh": null,
          "policyId": null,
          "sourceDoc": "Hawaii_2026_PA_Audit.md",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "Non-preferred status"
        }
      },
      "HI-COM-KAISER": {
        "CGRP mAbs (SC)": {
          "state": "HI",
          "payerName": "Kaiser Permanente Hawaii",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "Internal formulary criteria",
          "step1Duration": "Per Kaiser protocol",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "⚠️ Closed IDN - internal UM by employed physicians; no external PA adjudication; strict closed formulary",
          "contraBypass": "Per Kaiser internal criteria",
          "goldCardAvail": "N/A - Internal",
          "goldCardThresh": null,
          "policyId": "Kaiser Formulary",
          "sourceDoc": "Hawaii_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "HI-MCD-UHC": {
        "CGRP mAbs (SC)": {
          "state": "HI",
          "payerName": "UnitedHealthcare (QUEST)",
          "payerType": "Medicaid MCO",
          "lob": "Medicaid",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "Per HI QUEST PDL",
          "step1Duration": "Trial required",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "PDL limits",
          "contraBypass": "Yes",
          "goldCardAvail": "No",
          "goldCardThresh": null,
          "policyId": "UHC QUEST Policy",
          "sourceDoc": "Hawaii_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "HI-MAC-NORIDIAN": {
        "Neurotoxins": {
          "state": "HI",
          "payerName": "Noridian Healthcare Solutions",
          "payerType": "Medicare MAC",
          "lob": "Part B",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "Noridian finalized an updated botulinum toxin LCD effective February 22, 2026. New chronic migraine criteria: (a) headaches ≥15 days/month, ≥8 migraine days/month, ≥4 hours/migraine day, present ≥3 months; (b) trial and inadequate response to a 2-month trial of at least 1 agent in any 2 of: antidepressant class (amitriptyline, venlafaxine, nortriptyline, duloxetine), beta-blocker class (metoprolol, propranolol, timolol, nadolol, atenolol, nebivolol), or antiepileptic class (valproate sodium, div",
          "step1Duration": "Adequate trial",
          "step2Req": "Noridian finalized an updated botulinum toxin LCD effective February 22, 2026. New chronic migraine criteria: (a) headaches ≥15 days/month, ≥8 migraine days/month, ≥4 hours/migraine day, present ≥3 months; (b) trial and inadequate response to a 2-month trial of at least 1 agent in any 2 of: antidepressant class (amitriptyline, venlafaxine, nortriptyline, duloxetine), beta-blocker class (metoprolol, propranolol, timolol, nadolol, atenolol, nebivolol), or antiepileptic class (valproate sodium, div",
          "step2Duration": null,
          "quantityLimit": "155 units/12 weeks",
          "contraBypass": "Yes",
          "goldCardAvail": "N/A (Federal)",
          "goldCardThresh": null,
          "policyId": "LCD DL39909",
          "sourceDoc": "Q1-2026-Policy-Refresh",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "Final LCD L35170 explicitly requires objective documentation of CGRP therapy if used concurrently",
          "siteOfCare": "Noridian finalized an updated botulinum toxin LCD effective February 22, 2026. New chronic migraine criteria: (a) headaches ≥15 days/month, ≥8 migraine days/month, ≥4 hours/migraine day, present ≥3 months; (b) trial and inadequate response to a 2-month trial of at least 1 agent in any 2 of: antidepr"
        }
      },
      "ID-COM-BCID": {
        "CGRP mAbs (SC)": {
          "state": "ID",
          "payerName": "Blue Cross of Idaho",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "Trial required",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Monthly supply; Dominant payer (42%)",
          "contraBypass": "Yes - CV; teratogenic",
          "goldCardAvail": "No state mandate",
          "goldCardThresh": null,
          "policyId": "BCID Policy",
          "sourceDoc": "Idaho_2026_PA_Audit_Strategy",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Gepants (Acute)": {
          "state": "ID",
          "payerName": "Blue Cross of Idaho",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 triptans",
          "step1Duration": "Trial required",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Plan dependent",
          "contraBypass": "Yes - CV contraindication",
          "goldCardAvail": "No state mandate",
          "goldCardThresh": null,
          "policyId": "BCID Policy",
          "sourceDoc": "Idaho_2026_PA_Audit_Strategy",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Neurotoxins": {
          "state": "ID",
          "payerName": "Blue Cross of Idaho",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "Trial required",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "155 units/12 weeks",
          "contraBypass": "Yes",
          "goldCardAvail": "No state mandate",
          "goldCardThresh": null,
          "policyId": "BCID Medical Policy",
          "sourceDoc": "Idaho_2026_PA_Audit_Strategy",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        }
      },
      "ID-COM-UHC": {
        "CGRP mAbs (SC)": {
          "state": "ID",
          "payerName": "UnitedHealthcare",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral classes",
          "step1Duration": "Trial required",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Aimovig/Emgality preferred",
          "contraBypass": "Yes",
          "goldCardAvail": "Yes (UHC National)",
          "goldCardThresh": "≥92% approval rate",
          "policyId": "UHC CGRP Policy",
          "sourceDoc": "Idaho_2026_PA_Audit_Strategy",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "ID-MCD-IDDHW": {
        "CGRP mAbs (SC)": {
          "state": "ID",
          "payerName": "Idaho Medicaid (DHW)",
          "payerType": "Medicaid FFS",
          "lob": "Medicaid",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "Per ID DHW PDL",
          "step1Duration": "Trial required",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "PDL limits",
          "contraBypass": "Yes",
          "goldCardAvail": "No",
          "goldCardThresh": null,
          "policyId": "ID DHW PDL",
          "sourceDoc": "Idaho_2026_PA_Audit_Strategy",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "ID-MAC-NORIDIAN": {
        "Neurotoxins": {
          "state": "ID",
          "payerName": "Noridian Healthcare Solutions",
          "payerType": "Medicare MAC",
          "lob": "Part B",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "Mandatory failure of 1 agent in 2 distinct classes; mandatory documentation of biobehavioral therapy; mandatory reporting of concurrent/prior CGRP usage.",
          "step1Duration": "Adequate trial",
          "step2Req": "Noridian finalized an updated botulinum toxin LCD effective February 22, 2026. New chronic migraine criteria: (a) headaches ≥15 days/month, ≥8 migraine days/month, ≥4 hours/migraine day, present ≥3 months; (b) trial and inadequate response to a 2-month trial of at least 1 agent in any 2 of: antidepressant class (amitriptyline, venlafaxine, nortriptyline, duloxetine), beta-blocker class (metoprolol, propranolol, timolol, nadolol, atenolol, nebivolol), or antiepileptic class (valproate sodium, div",
          "step2Duration": null,
          "quantityLimit": "155 units/12 weeks",
          "contraBypass": "Yes",
          "goldCardAvail": "N/A (Federal)",
          "goldCardThresh": null,
          "policyId": "LCD DL39909",
          "sourceDoc": "Q1-2026-Policy-Refresh",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series.",
          "siteOfCare": "Noridian finalized an updated botulinum toxin LCD effective February 22, 2026. New chronic migraine criteria: (a) headaches ≥15 days/month, ≥8 migraine days/month, ≥4 hours/migraine day, present ≥3 months; (b) trial and inadequate response to a 2-month trial of at least 1 agent in any 2 of: antidepr",
          "concurrentTherapy": "Mandatory failure of 1 agent in 2 distinct classes; mandatory documentation of biobehavioral therapy; mandatory reporting of concurrent/prior CGRP usage."
        }
      },
      "MT-COM-BCBSMT": {
        "CGRP mAbs (SC)": {
          "state": "MT",
          "payerName": "Blue Cross Blue Shield Montana",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "≥8 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "SB 449 Continuity of Care (90 days); SB 449 = statutory override for plan transitions",
          "contraBypass": "Yes - teratogenic; cognitive; respiratory",
          "goldCardAvail": "⚠️ No statutory Gold Card",
          "goldCardThresh": null,
          "policyId": "BCBSMT Formulary",
          "sourceDoc": "Montana_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Gepants (Acute)": {
          "state": "MT",
          "payerName": "Blue Cross Blue Shield Montana",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 triptans",
          "step1Duration": "Documented",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": ">40% market; Prime Therapeutics/Carelon; 'utilization friction' strategy documented",
          "contraBypass": "Yes - CV contraindication",
          "goldCardAvail": "⚠️ No statutory Gold Card",
          "goldCardThresh": null,
          "policyId": "BCBSMT Formulary",
          "sourceDoc": "Montana_2026_PA_Audit",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Neurotoxins": {
          "state": "MT",
          "payerName": "Blue Cross Blue Shield Montana (HCSC)",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "Trial required",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "155 units/12 weeks",
          "contraBypass": "Yes",
          "goldCardAvail": "No state mandate",
          "goldCardThresh": null,
          "policyId": "BCBSMT Medical Policy",
          "sourceDoc": "Montana_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        },
        "Gepants (Preventive)": {
          "state": "MT",
          "payerName": "BCBS Montana",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Preventive)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "Fail 1 injectable CGRP (Aimovig/Emgality/Ajovy)",
          "step1Duration": "≥8 weeks",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "16 tabs/30 days",
          "contraBypass": "Yes - standard",
          "goldCardAvail": "No",
          "goldCardThresh": null,
          "policyId": null,
          "sourceDoc": "Montana_2026_PA_Audit.md",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "Step 2 preventive - requires mAb trial first"
        }
      },
      "MT-COM-UHC": {
        "CGRP mAbs (SC)": {
          "state": "MT",
          "payerName": "UnitedHealthcare",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral classes",
          "step1Duration": "Trial required",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Aimovig/Emgality preferred",
          "contraBypass": "Yes",
          "goldCardAvail": "Yes (UHC National)",
          "goldCardThresh": "≥92% approval rate",
          "policyId": "UHC CGRP Policy",
          "sourceDoc": "Montana_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "MT-MCD-MTDPHHS": {
        "CGRP mAbs (SC)": {
          "state": "MT",
          "payerName": "Montana Medicaid (DPHHS)",
          "payerType": "Medicaid FFS",
          "lob": "Medicaid",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "Per MT DPHHS PDL",
          "step1Duration": "Trial required",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "PDL limits",
          "contraBypass": "Yes",
          "goldCardAvail": "No",
          "goldCardThresh": null,
          "policyId": "MT DPHHS PDL",
          "sourceDoc": "Montana_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "MT-MAC-NORIDIAN": {
        "Neurotoxins": {
          "state": "MT",
          "payerName": "Noridian Healthcare Solutions",
          "payerType": "Medicare MAC",
          "lob": "Part B",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "Per LCD DL39909",
          "step1Duration": "Adequate trial",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "155 units/12 weeks",
          "contraBypass": "Yes",
          "goldCardAvail": "N/A (Federal)",
          "goldCardThresh": null,
          "policyId": "LCD DL39909",
          "sourceDoc": "Montana_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        }
      },
      "ND-COM-NDAKBCBS": {
        "CGRP mAbs (SC)": {
          "state": "ND",
          "payerName": "Blue Cross Blue Shield North Dakota",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "First-Line for Chronic Migraine (≥15 days/mo) per 2026 update",
          "step1Duration": null,
          "step2Req": "Episodic still requires ≥2 classes",
          "step2Duration": "≥2 months each",
          "quantityLimit": "Monthly supply; Dominant payer (48%)",
          "contraBypass": "Yes - CV; teratogenic",
          "goldCardAvail": "Yes (SB 2280)",
          "goldCardThresh": "90% approval rate",
          "policyId": "BCBSND 2026 Policy",
          "sourceDoc": "North_Dakota_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Gepants (Acute)": {
          "state": "ND",
          "payerName": "Blue Cross Blue Shield North Dakota",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 triptans",
          "step1Duration": "≥30 days each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Plan dependent",
          "contraBypass": "Yes - CV; serotonin syndrome",
          "goldCardAvail": "Yes (SB 2280)",
          "goldCardThresh": "90% approval rate",
          "policyId": "BCBSND Policy",
          "sourceDoc": "North_Dakota_2026_PA_Audit",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Neurotoxins": {
          "state": "ND",
          "payerName": "Blue Cross Blue Shield North Dakota",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "Trial required",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "155 units/12 weeks",
          "contraBypass": "Yes",
          "goldCardAvail": "Yes (SB 2280)",
          "goldCardThresh": "90% approval rate",
          "policyId": "BCBSND Medical Policy",
          "sourceDoc": "North_Dakota_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        }
      },
      "ND-COM-SANFORD": {
        "CGRP mAbs (SC)": {
          "state": "ND",
          "payerName": "Sanford Health Plan",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes (Integrated System)",
          "step1Duration": "Trial required",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Direct EMR data access",
          "contraBypass": "Yes - CV; teratogenic",
          "goldCardAvail": "No state-specific",
          "goldCardThresh": null,
          "policyId": "Sanford Policy",
          "sourceDoc": "North_Dakota_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "ND-COM-UHC": {
        "CGRP mAbs (SC)": {
          "state": "ND",
          "payerName": "UnitedHealthcare",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral classes",
          "step1Duration": "Trial required",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Aimovig/Emgality preferred",
          "contraBypass": "Added bypass for pediatric patients",
          "goldCardAvail": "Yes (UHC National + State)",
          "goldCardThresh": "≥92% approval rate",
          "policyId": "UHC CGRP Policy",
          "sourceDoc": "Q1-2026-Policy-Refresh",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "ND-MCD-NDDHS": {
        "Gepants (Acute)": {
          "state": "ND",
          "payerName": "North Dakota Medicaid (DHS)",
          "payerType": "Medicaid FFS",
          "lob": "Medicaid",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "Failed 30-day trial of two triptans (one nasal) and failed 30-day trial of Nurtec ODT, Ubrelvy, and Reyvow",
          "step1Duration": "≥30-day trial each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "PDL limits",
          "contraBypass": "Yes - CV contraindication",
          "goldCardAvail": "No",
          "goldCardThresh": null,
          "policyId": "ND DHS PDL",
          "sourceDoc": "Q1-2026-Policy-Refresh",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "CGRP mAbs (SC)": {
          "state": "ND",
          "payerName": "North Dakota Medicaid (DHS)",
          "payerType": "Medicaid FFS",
          "lob": "Medicaid",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 drug classes",
          "step1Duration": "≥2 months each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "PDL limits; Acentra Health reviews",
          "contraBypass": "Yes - comorbidity bypass",
          "goldCardAvail": "No",
          "goldCardThresh": null,
          "policyId": "ND DHS PA Criteria",
          "sourceDoc": "North_Dakota_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "ND-MAC-NORIDIAN": {
        "Neurotoxins": {
          "state": "ND",
          "payerName": "Noridian Healthcare Solutions",
          "payerType": "Medicare MAC",
          "lob": "Part B",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "Inadequate response to at least one agent in two classes of completed medications",
          "step1Duration": "Adequate trial",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "155 units/12 weeks",
          "contraBypass": "Yes",
          "goldCardAvail": "N/A (Federal)",
          "goldCardThresh": null,
          "policyId": "LCD DL39909",
          "sourceDoc": "Q1-2026-Policy-Refresh",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "Documentation of concurrent or previous CGRP therapy required"
        }
      },
      "NJ-COM-HORBCBS": {
        "CGRP mAbs (SC)": {
          "state": "NJ",
          "payerName": "Horizon Blue Cross Blue Shield NJ",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥1 oral preventive class (Topiramate, Propranolol, or Amitriptyline); lower barrier than most states",
          "step1Duration": "≥8 weeks",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "⚠️ NetResults often EXCLUDES Aimovig in favor of Ajovy (rebate-driven); use A1825 'Stability' override if forced switch from Aimovig to Ajovy",
          "contraBypass": "Yes - side effect intolerance (cognitive slowing for Topiramate); A1825 Condition 5 (Stability) if switching stable patient",
          "goldCardAvail": "A1825 Step Therapy Override",
          "goldCardThresh": "72h response or deemed approved",
          "policyId": "Horizon CGRP Policy",
          "sourceDoc": "New_Jersey_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Gepants (Acute)": {
          "state": "NJ",
          "payerName": "Horizon Blue Cross Blue Shield NJ",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 preferred triptans (Rizatriptan, Sumatriptan, Naratriptan); documentation must include dates of service or pharmacy fill history",
          "step1Duration": "Documented failure",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "QL strictly enforced 16 tabs/30d; NetResults formulary highly restrictive",
          "contraBypass": "Yes - CV contraindication (ischemic heart disease/stroke/TIA/uncontrolled HTN/PVD) = 'Vascular Contraindication' bypass via A1825 Condition 1",
          "goldCardAvail": "A1825 Step Therapy Override",
          "goldCardThresh": "72h response or deemed approved",
          "policyId": "Horizon Gepant Policy",
          "sourceDoc": "New_Jersey_2026_PA_Audit",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Neurotoxins": {
          "state": "NJ",
          "payerName": "Horizon Blue Cross Blue Shield NJ",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes,≥8 weeks each,N/A",
          "step1Duration": null,
          "step2Req": "Chronic Migraine (≥15 days/mo",
          "step2Duration": " ≥8 migrainous",
          "quantityLimit": " ≥3 months); OMNIA tiered structure",
          "contraBypass": "Yes - oral preventive contraindications; teratogenic bypass",
          "goldCardAvail": "A1825 applies",
          "goldCardThresh": "72h response or deemed approved",
          "policyId": "Horizon Botox Policy",
          "sourceDoc": "New_Jersey_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        },
        "CGRP mAbs (IV)": {
          "state": "NJ",
          "payerName": "Horizon Blue Cross Blue Shield NJ",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (IV)",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "≥8 weeks each",
          "step2Req": "Medical Necessity for infusion",
          "step2Duration": "Documented",
          "quantityLimit": "J3032; requires medical necessity for IV setting",
          "contraBypass": "concurrent therapy restriction added (member will not be using in combination with another CGRP agent)",
          "goldCardAvail": "A1825 applies",
          "goldCardThresh": "72h response",
          "policyId": "Horizon Vyepti Policy",
          "sourceDoc": "Q1-2026-Policy-Refresh",
          "denialCode": "DENY-QL-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "NJ-COM-AETNA": {
        "CGRP mAbs (SC)": {
          "state": "NJ",
          "payerName": "Aetna NJ",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥0-1 oral preventive class (lower barrier)",
          "step1Duration": "≥8 weeks if required",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Renewal often requires 50% reduction in migraine days; Cluster Headache (Emgality 300mg) requires Verapamil/Lithium failure - do NOT use migraine PA form for cluster",
          "contraBypass": "Yes - teratogenic; CV contraindication; documented intolerance",
          "goldCardAvail": "A1825 applies",
          "goldCardThresh": "72h response",
          "policyId": "Aetna CGRP CPB",
          "sourceDoc": "New_Jersey_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Gepants (Acute)": {
          "state": "NJ",
          "payerName": "Aetna NJ",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes (Auto-Bypass Available)",
          "step1Req": "⚠️ 'Smart Edit' automation: if PBM detects 2 distinct triptan claims in patient history within 180 days, Gepant auto-pays at POS; if no claims visible, manual PA required with 'inadequate response or intolerance' attestation",
          "step1Duration": "Claims-based or manual attestation",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "If patient tried samples/triptans under different insurance, system won't see it - MUST submit manual PA documenting those trials",
          "contraBypass": "Yes - CV contraindication; provide pharmacy fill records from previous insurers if needed",
          "goldCardAvail": "A1825 applies",
          "goldCardThresh": "72h response",
          "policyId": "Aetna Gepant Policy",
          "sourceDoc": "New_Jersey_2026_PA_Audit",
          "denialCode": "DENY-HEMI-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Neurotoxins": {
          "state": "NJ",
          "payerName": "Aetna NJ",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "≥8 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "CPB 0113; Chronic Migraine; coded data more important than medical necessity letter",
          "contraBypass": "Yes - oral preventive contraindications",
          "goldCardAvail": "A1825 applies",
          "goldCardThresh": "72h response",
          "policyId": "Aetna CPB 0113",
          "sourceDoc": "New_Jersey_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        }
      },
      "NJ-COM-UHC": {
        "CGRP mAbs (SC)": {
          "state": "NJ",
          "payerName": "UnitedHealthcare NJ (Oxford)",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥1-2 oral preventive classes",
          "step1Duration": "≥8 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "PREFERRED: Aimovig, Emgality; Ajovy/Vyepti often NON-PREFERRED; Vyepti requires 'failure of self-injection' or 'needle phobia' or 'absorption issues'",
          "contraBypass": "Yes - teratogenic; CV contraindication; documented intolerance",
          "goldCardAvail": "UHC Gold Card + A1825",
          "goldCardThresh": "92% threshold",
          "policyId": "UHC CGRP Policy",
          "sourceDoc": "New_Jersey_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Gepants (Acute)": {
          "state": "NJ",
          "payerName": "UnitedHealthcare NJ (Oxford)",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 triptans; documentation of dates of service required; AI review checks for gaps in therapy",
          "step1Duration": "Documented with dates",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Zavzpret requires DOUBLE STEP: fail triptans + oral gepants (Ubrelvy/Nurtec) unless GI contraindication documented",
          "contraBypass": "Yes - CV contraindication; GI bypass for Zavzpret ('Gastric Stasis' = severe nausea/vomiting)",
          "goldCardAvail": "UHC Gold Card + A1825",
          "goldCardThresh": "92% threshold",
          "policyId": "UHC Gepant Policy",
          "sourceDoc": "New_Jersey_2026_PA_Audit",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Neurotoxins": {
          "state": "NJ",
          "payerName": "UnitedHealthcare NJ (Oxford)",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "≥8 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Gold Card program available; high-performing providers bypass PA; if not Gold Carded strict step therapy applies",
          "contraBypass": "Yes - oral preventive contraindications",
          "goldCardAvail": "UHC Gold Card ACTIVE",
          "goldCardThresh": "92% threshold for CPT 64615",
          "policyId": "UHC Botox Policy",
          "sourceDoc": "New_Jersey_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        },
        "CGRP mAbs (IV)": {
          "state": "NJ",
          "payerName": "UnitedHealthcare NJ (Oxford)",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (IV)",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "≥8 weeks each",
          "step2Req": "Justify IV infusion setting",
          "step2Duration": "Documented",
          "quantityLimit": "J3032; UHC scrutinizes IV infusions; must document 'failure of self-injection' OR 'needle phobia' OR 'absorption issues'",
          "contraBypass": "Yes - needle phobia; inability to self-inject; SC absorption failure",
          "goldCardAvail": "UHC Gold Card + A1825",
          "goldCardThresh": "92% threshold",
          "policyId": "UHC Vyepti Policy",
          "sourceDoc": "New_Jersey_2026_PA_Audit",
          "denialCode": "DENY-QL-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Gepants (Preventive)": {
          "state": "NJ",
          "payerName": "UHC NJ",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Preventive)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "Per UHC protocol",
          "step1Duration": "≥8 weeks",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "30 tabs/30 days",
          "contraBypass": "Yes - standard",
          "goldCardAvail": "No",
          "goldCardThresh": null,
          "policyId": null,
          "sourceDoc": "New_Jersey_2026_PA_Audit.docx",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "UHC PA notification applies"
        }
      },
      "NJ-MCD-NJFC": {
        "CGRP mAbs (SC)": {
          "state": "NJ",
          "payerName": "NJ FamilyCare (Medicaid)",
          "payerType": "Medicaid Unified",
          "lob": "Medicaid",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes per PDL",
          "step1Duration": "≥8 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "PDL adherence required; ⚠️ MOH (Medication Overuse Headache) assessment documentation REQUIRED",
          "contraBypass": "Yes - teratogenic; CV contraindication; documented intolerance",
          "goldCardAvail": "A1825 applies to NJ FamilyCare",
          "goldCardThresh": "72h response",
          "policyId": "NJ FamilyCare PDL",
          "sourceDoc": "New_Jersey_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Gepants (Acute)": {
          "state": "NJ",
          "payerName": "NJ FamilyCare (Medicaid)",
          "payerType": "Medicaid Unified",
          "lob": "Medicaid",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 triptans per PDL",
          "step1Duration": "Documented failure",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "PDL adherence required; specific state fax forms",
          "contraBypass": "Yes - CV contraindication",
          "goldCardAvail": "A1825 applies to NJ FamilyCare",
          "goldCardThresh": "72h response",
          "policyId": "NJ FamilyCare PDL",
          "sourceDoc": "New_Jersey_2026_PA_Audit",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Neurotoxins": {
          "state": "NJ",
          "payerName": "NJ FamilyCare (Medicaid)",
          "payerType": "Medicaid Unified",
          "lob": "Medical Benefit",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "≥8 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "⚠️ MOH assessment documentation REQUIRED; use specific state fax forms",
          "contraBypass": "Yes - oral preventive contraindications",
          "goldCardAvail": "A1825 applies",
          "goldCardThresh": "72h response",
          "policyId": "NJ FamilyCare Medical",
          "sourceDoc": "New_Jersey_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        }
      },
      "NJ-MAC-NOVITAS": {
        "Neurotoxins": {
          "state": "NJ",
          "payerName": "Novitas Solutions",
          "payerType": "Medicare MAC",
          "lob": "Part B",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "⚠️ WISeR PILOT: Pre-Service PA MANDATORY starting Jan 1 2026; fail ≥2 classes of oral prophylaxis (Beta-blockers, Anticonvulsants, TCAs)",
          "step1Duration": "Documented with dates/reasons",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "LCD L35170/L39909; AI-based review; Chronic Migraine (G43.719); ≥15 HA days with ≥8 migrainous for ≥3 months; ⚠️ HIT-6 or MIDAS score REQUIRED for AI review; renewal requires QUANTITATIVE data (e.g., 'reduced from 20 to 10 days/month') - 'patient feels better' INSUFFICIENT; ⚠️ Billing without PA = Pre-Payment Review (cash flow freeze)",
          "contraBypass": "Yes - documented oral failures with specific adverse events",
          "goldCardAvail": "WISeR Gold Card - earn exemption through compliance",
          "goldCardThresh": "High approval rate in initial phase",
          "policyId": "LCD L35170/L39909",
          "sourceDoc": "New_Jersey_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        }
      },
      "RI-COM-RIBCBS": {
        "CGRP mAbs (SC)": {
          "state": "RI",
          "payerName": "Blue Cross Blue Shield Rhode Island",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes; \"3 drugs from 2 classes\" rule",
          "step1Duration": "Trial required",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Monthly supply; Dominant payer (57-58%)",
          "contraBypass": "Yes - CV; teratogenic",
          "goldCardAvail": "No (PA Reform excludes Rx)",
          "goldCardThresh": null,
          "policyId": "BCBSRI Policy",
          "sourceDoc": "Rhode_Island_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Gepants (Acute)": {
          "state": "RI",
          "payerName": "Blue Cross Blue Shield Rhode Island",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 triptans",
          "step1Duration": "Trial required",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Plan dependent; CGRPs count as class for Botox step",
          "contraBypass": "Yes - CV contraindication",
          "goldCardAvail": "No (PA Reform excludes Rx)",
          "goldCardThresh": null,
          "policyId": "BCBSRI Policy",
          "sourceDoc": "Rhode_Island_2026_PA_Audit",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Neurotoxins": {
          "state": "RI",
          "payerName": "Blue Cross Blue Shield Rhode Island",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "Trial required",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "155 units/12 weeks",
          "contraBypass": "Yes",
          "goldCardAvail": "No (PA Reform excludes Rx)",
          "goldCardThresh": null,
          "policyId": "BCBSRI Medical Policy",
          "sourceDoc": "Rhode_Island_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        }
      },
      "RI-MCD-RINEIGH": {
        "CGRP mAbs (SC)": {
          "state": "RI",
          "payerName": "Neighborhood Health Plan of RI",
          "payerType": "Medicaid MCO",
          "lob": "Medicaid",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral classes; Nurtec Non-Formulary; Ubrelvy preferred",
          "step1Duration": "Trial required",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Restrictive; cost-containment focus",
          "contraBypass": "Yes - documented intolerance",
          "goldCardAvail": "No",
          "goldCardThresh": null,
          "policyId": "NHPRI Policy",
          "sourceDoc": "Rhode_Island_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "RI-COM-UHC": {
        "CGRP mAbs (SC)": {
          "state": "RI",
          "payerName": "UnitedHealthcare",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral classes; MA dominant (>30%)",
          "step1Duration": "Trial required",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Aimovig/Emgality preferred; Ajovy non-preferred",
          "contraBypass": "Yes",
          "goldCardAvail": "Yes (UHC National)",
          "goldCardThresh": "≥92% approval rate",
          "policyId": "UHC CGRP Policy",
          "sourceDoc": "Rhode_Island_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "RI-COM-TUFTS": {
        "CGRP mAbs (SC)": {
          "state": "RI",
          "payerName": "Point32Health (Tufts)",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "Select formulary exclusionary logic",
          "step1Duration": "Trial required",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Monthly supply",
          "contraBypass": "Yes",
          "goldCardAvail": "No state mandate",
          "goldCardThresh": null,
          "policyId": "Point32Health Policy",
          "sourceDoc": "Rhode_Island_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "RI-MAC-NOVITAS": {
        "Neurotoxins": {
          "state": "RI",
          "payerName": "Novitas Solutions",
          "payerType": "Medicare MAC",
          "lob": "Part B",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "Per LCD DL39909; \"Conservative Tx\" requirement",
          "step1Duration": "Adequate trial",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "155 units/12 weeks",
          "contraBypass": "Yes",
          "goldCardAvail": "N/A (Federal)",
          "goldCardThresh": null,
          "policyId": "LCD DL39909",
          "sourceDoc": "Rhode_Island_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        }
      },
      "SD-COM-AVERA": {
        "CGRP mAbs (SC)": {
          "state": "SD",
          "payerName": "Avera Health Plans",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral classes; Emgality/Ajovy preferred; Aimovig non-preferred",
          "step1Duration": "≥2 months each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Dominant payer (33%); needle phobia bypass for oral",
          "contraBypass": "Yes - needle phobia (F40.230)",
          "goldCardAvail": "No (SB 158 failed)",
          "goldCardThresh": null,
          "policyId": "Avera Policy",
          "sourceDoc": "South_Dakota_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Neurotoxins": {
          "state": "SD",
          "payerName": "Avera Health Plans",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes; headache diary audits",
          "step1Duration": "Trial required",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "155 units/12 weeks; 15+ days documented",
          "contraBypass": "Yes",
          "goldCardAvail": "No (SB 158 failed)",
          "goldCardThresh": null,
          "policyId": "Avera Medical Policy",
          "sourceDoc": "South_Dakota_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        }
      },
      "SD-COM-SANFORD": {
        "CGRP mAbs (SC)": {
          "state": "SD",
          "payerName": "Sanford Health Plan South Dakota",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "≥8 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Integrated pay-vider; EMR discrepancy detection; ⚠️ SB 158 FAILED - no Gold Card",
          "contraBypass": "Yes - teratogenic; cognitive; respiratory",
          "goldCardAvail": "⚠️ SB 158 FAILED",
          "goldCardThresh": null,
          "policyId": "Sanford Formulary",
          "sourceDoc": "South_Dakota_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Neurotoxins": {
          "state": "SD",
          "payerName": "Sanford Health Plan",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes; Dual therapy approved for refractory",
          "step1Duration": "Trial required",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "155 units/12 weeks",
          "contraBypass": "Yes - AHS 2024 synergy",
          "goldCardAvail": "No (SB 158 failed)",
          "goldCardThresh": null,
          "policyId": "Sanford Medical Policy",
          "sourceDoc": "South_Dakota_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        }
      },
      "SD-COM-WELLMARK": {
        "CGRP mAbs (SC)": {
          "state": "SD",
          "payerName": "Wellmark BCBS SD",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral classes; Ajovy/Emgality preferred; Aimovig third-line",
          "step1Duration": "≥2 months each",
          "step2Req": "Vyepti requires 2 SC CGRP fails",
          "step2Duration": null,
          "quantityLimit": "Monthly supply",
          "contraBypass": "Yes",
          "goldCardAvail": "No (SB 158 failed)",
          "goldCardThresh": null,
          "policyId": "Wellmark SD Policy",
          "sourceDoc": "South_Dakota_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "SD-MCD-SDDSS": {
        "CGRP mAbs (SC)": {
          "state": "SD",
          "payerName": "South Dakota Medicaid",
          "payerType": "Medicaid FFS",
          "lob": "Medicaid",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "Per SD DSS PDL",
          "step1Duration": "Trial required",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "PDL limits",
          "contraBypass": "Yes",
          "goldCardAvail": "No",
          "goldCardThresh": null,
          "policyId": "SD DSS PDL",
          "sourceDoc": "South_Dakota_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "SD-MAC-NORIDIAN": {
        "Neurotoxins": {
          "state": "SD",
          "payerName": "Noridian Healthcare Solutions",
          "payerType": "Medicare MAC",
          "lob": "Part B",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "Per LCD L35170; G43.701/709/711/719 codes only",
          "step1Duration": "Adequate trial",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "155 units/12 weeks; JW modifier mandatory",
          "contraBypass": "Yes",
          "goldCardAvail": "N/A (Federal)",
          "goldCardThresh": null,
          "policyId": "LCD L35170",
          "sourceDoc": "Q1-2026-Policy-Refresh",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "Concurrent therapy with a CGRP agent for migraine prophylaxis is covered if the beneficiary has had further reduction in the overall number of migraine days or reduction in number of severe migraine days per month compared to monotherapy with the initial agent."
        }
      },
      "VT-COM-VERBCBS": {
        "CGRP mAbs (SC)": {
          "state": "VT",
          "payerName": "Blue Cross Blue Shield Vermont",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "Trial required",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Monthly supply; Dominant payer (57%)",
          "contraBypass": "Yes - CV; teratogenic",
          "goldCardAvail": "No state mandate",
          "goldCardThresh": null,
          "policyId": "BCBSVT Policy",
          "sourceDoc": "Vermont_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Gepants (Acute)": {
          "state": "VT",
          "payerName": "Blue Cross Blue Shield Vermont",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 triptans",
          "step1Duration": "Trial required",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Plan dependent",
          "contraBypass": "Yes - CV contraindication",
          "goldCardAvail": "No state mandate",
          "goldCardThresh": null,
          "policyId": "BCBSVT Policy",
          "sourceDoc": "Vermont_2026_PA_Audit",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Neurotoxins": {
          "state": "VT",
          "payerName": "Blue Cross Blue Shield Vermont",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "Trial required",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "155 units/12 weeks",
          "contraBypass": "Yes",
          "goldCardAvail": "No state mandate",
          "goldCardThresh": null,
          "policyId": "BCBSVT Medical Policy",
          "sourceDoc": "Vermont_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        }
      },
      "VT-COM-MVPHEALTH": {
        "CGRP mAbs (SC)": {
          "state": "VT",
          "payerName": "MVP Health Care",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral classes; Formulary updates Feb 1 2026",
          "step1Duration": "Trial required",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Monthly supply",
          "contraBypass": "Yes",
          "goldCardAvail": "No state mandate",
          "goldCardThresh": null,
          "policyId": "MVP Policy",
          "sourceDoc": "Vermont_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "VT-MCD-VTDVHA": {
        "CGRP mAbs (SC)": {
          "state": "VT",
          "payerName": "Vermont Medicaid (DVHA)",
          "payerType": "Medicaid FFS",
          "lob": "Medicaid",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "Per VT DVHA PDL",
          "step1Duration": "Trial required",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "PDL limits",
          "contraBypass": "Yes",
          "goldCardAvail": "No",
          "goldCardThresh": null,
          "policyId": "VT DVHA PDL",
          "sourceDoc": "Vermont_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "VT-MAC-NGS": {
        "Neurotoxins": {
          "state": "VT",
          "payerName": "National Government Services",
          "payerType": "Medicare MAC",
          "lob": "Part B",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "NGS finalized updated botulinum toxin LCD effective February 22, 2026. New chronic migraine coverage criteria: (a) headaches ≥15 days/month, ≥8 migraine days/month, ≥4 hours/migraine day, present ≥3 months; (b) trial and inadequate response to a 2-month trial of at least 1 agent in any 2 of: antidepressant class, beta-blocker class, or antiepileptic class; (c) enhanced documentation requirements at baseline and following each injection session. NGS was one of 5 MACs (with CGS, Noridian, WPS, Pal",
          "step1Duration": "NGS finalized updated botulinum toxin LCD effective February 22, 2026. New chronic migraine coverage criteria: (a) headaches ≥15 days/month, ≥8 migraine days/month, ≥4 hours/migraine day, present ≥3 months; (b) trial and inadequate response to a 2-month trial of at least 1 agent in any 2 of: antidepressant class, beta-blocker class, or antiepileptic class; (c) enhanced documentation requirements at baseline and following each injection session. NGS was one of 5 MACs (with CGS, Noridian, WPS, Pal",
          "step2Req": "LCD L35172 explicitly requires documentation supporting trials of an inadequate response to at least one agent in two different classes of oral medications; introduces a mandatory requirement for documentation regarding CGRP therapy.",
          "step2Duration": null,
          "quantityLimit": "155 units/12 weeks",
          "contraBypass": "Yes",
          "goldCardAvail": "N/A (Federal)",
          "goldCardThresh": null,
          "policyId": "LCD DL39909",
          "sourceDoc": "Q1-2026-Policy-Refresh",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "LCD L35172 explicitly requires documentation supporting trials of an inadequate response to at least one agent in two different classes of oral medications; introduces a mandatory requirement for documentation regarding CGRP therapy."
        }
      },
      "MA-COM-MASSBCBS": {
        "CGRP mAbs (SC)": {
          "state": "MA",
          "payerName": "Blue Cross Blue Shield of Massachusetts",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 different classes of standard preventives (Beta-blockers, Antidepressants, CALCIUM CHANNEL BLOCKERS, Anticonvulsants); ⚠️ CCBs (Verapamil) COUNT as valid step - if patient tried Verapamil for any reason, document it",
          "step1Duration": "Documented failure each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "PREFERRED (Formulary): Ajovy, Emgality, Nurtec ODT, Qulipta; NON-PREFERRED: Aimovig, Vyepti; ⚠️ To access Aimovig/Vyepti must fail 2 Formulary CGRPs (step-within-step); ⚠️ CRITICAL: Policy 006 (Jan 1 2026) says CGRPs are 'first-line' - USE THIS TO APPEAL step therapy denials from Policy 021",
          "contraBypass": "Yes - teratogenic; CV contraindication; documented intolerance; cite Policy 006 'first-line' to bypass Policy 021 step therapy",
          "goldCardAvail": "NO - H.4616 pending",
          "goldCardThresh": null,
          "policyId": "BCBSMA Policy 021/006",
          "sourceDoc": "Massachusetts_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Gepants (Acute)": {
          "state": "MA",
          "payerName": "Blue Cross Blue Shield of Massachusetts",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "Step 1 (Open): Naratriptan/Rizatriptan/Sumatriptan; Step 2 (PA): Almotriptan/Eletriptan/Frovatriptan/Zolmitriptan - requires 1 Step 1 agent; Step 3 (Nurtec/Ubrelvy): requires ≥2 triptan failures",
          "step1Duration": "Documented failure per step",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Standard criteria; 12-month approval duration",
          "contraBypass": "Yes - CV contraindication (bypass all triptans)",
          "goldCardAvail": "NO - H.4616 pending",
          "goldCardThresh": null,
          "policyId": "BCBSMA Policy 021",
          "sourceDoc": "Massachusetts_2026_PA_Audit",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Neurotoxins": {
          "state": "MA",
          "payerName": "Blue Cross Blue Shield of Massachusetts",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "CGRP inhibitors added as an option for first-line treatment of prevention of migraine",
          "step1Duration": "Documented failure",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Chronic Migraine (≥15 days/month with ≥4 hours duration); ⚠️ Policy 006 explicitly states 'CGRP inhibitors as option for first-line treatment of prevention of migraine' - CONTRADICTS step therapy in Policy 021",
          "contraBypass": "Yes - oral preventive contraindications",
          "goldCardAvail": "NO - H.4616 pending",
          "goldCardThresh": null,
          "policyId": "BCBSMA Policy 006",
          "sourceDoc": "Q1-2026-Policy-Refresh",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        },
        "CGRP mAbs (Cluster)": {
          "state": "MA",
          "payerName": "Blue Cross Blue Shield of Massachusetts",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (Cluster)",
          "medCategory": "Cluster Headache",
          "stepTherapyRequired": "Yes",
          "step1Req": "Episodic Cluster Headache; history of 5+ attacks per month; failure of standard prevention (Verapamil, Lithium, Topiramate)",
          "step1Duration": "Documented failure standard prevention",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Emgality 100mg for Episodic Cluster Headache (NOT chronic cluster - often excluded)",
          "contraBypass": "Yes - standard prevention contraindications",
          "goldCardAvail": "NO - H.4616 pending",
          "goldCardThresh": null,
          "policyId": "BCBSMA Policy 021",
          "sourceDoc": "Massachusetts_2026_PA_Audit",
          "denialCode": "DENY-QL-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "MA-COM-HARVARD": {
        "CGRP mAbs (SC)": {
          "state": "MA",
          "payerName": "Point32Health (Harvard Pilgrim)",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "Trial required",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Monthly supply",
          "contraBypass": "Yes",
          "goldCardAvail": "No state mandate",
          "goldCardThresh": null,
          "policyId": "Harvard Pilgrim Policy",
          "sourceDoc": "Massachusetts_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "MA-COM-TUFTS": {
        "CGRP mAbs (SC)": {
          "state": "MA",
          "payerName": "Point32Health (Tufts)",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral classes; Tufts Health Together MCO exit (member reassignment)",
          "step1Duration": "Trial required",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Monthly supply; 90-day continuity mandate",
          "contraBypass": "Yes",
          "goldCardAvail": "No state mandate",
          "goldCardThresh": null,
          "policyId": "Tufts Policy",
          "sourceDoc": "Massachusetts_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "MA-COM-UHC": {
        "CGRP mAbs (SC)": {
          "state": "MA",
          "payerName": "UnitedHealthcare",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral classes",
          "step1Duration": "Trial required",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Aimovig/Emgality preferred",
          "contraBypass": "Yes",
          "goldCardAvail": "Yes (UHC National)",
          "goldCardThresh": "≥92% approval rate",
          "policyId": "UHC CGRP Policy",
          "sourceDoc": "Massachusetts_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "MA-MCD-MASSHEALTH": {
        "CGRP mAbs (SC)": {
          "state": "MA",
          "payerName": "MassHealth (Medicaid)",
          "payerType": "Medicaid Unified",
          "lob": "Medicaid",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "'1+1 Protocol': ≥1 Beta-blocker (Atenolol/metoprolol/nadolol/propranolol/timolol) AND ≥1 Other Class Agent (Topiramate/TCA/valproic acid/venlafaxine)",
          "step1Duration": "Documented failure each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Age restriction: ≥18 years (excludes pediatric approvals); PREFERRED CGRPs via UPPL; ACOs CANNOT impose stricter criteria than MHDL - appeal via 130 CMR 406.000",
          "contraBypass": "Yes - teratogenic; CV contraindication; documented intolerance; ACO denials using 'commercial-style' criteria = regulatory violation",
          "goldCardAvail": "NO - H.4616 pending",
          "goldCardThresh": null,
          "policyId": "MHDL Table 14",
          "sourceDoc": "Massachusetts_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Gepants (Acute)": {
          "state": "MA",
          "payerName": "MassHealth (Medicaid)",
          "payerType": "Medicaid Unified",
          "lob": "Medicaid",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 different triptan agents (Sumatriptan, Rizatriptan, Naratriptan preferred); document inadequate response/adverse reaction/contraindication",
          "step1Duration": "Documented failure",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "⚠️ QL 16 units per 30 days; to exceed: document headache frequency + concurrent prophylaxis OR contraindication to prophylaxis (signals managing chronic condition)",
          "contraBypass": "Yes - CV contraindication; Rizatriptan contraindicated if on Propranolol (drug-drug interaction); documented contraindication satisfies step per 130 CMR 406.000",
          "goldCardAvail": "NO - H.4616 pending",
          "goldCardThresh": null,
          "policyId": "MHDL Table 14",
          "sourceDoc": "Massachusetts_2026_PA_Audit",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Neurotoxins": {
          "state": "MA",
          "payerName": "MassHealth (Medicaid)",
          "payerType": "Medicaid Unified",
          "lob": "Medical Benefit",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 classes of oral preventives (Anti-epileptics/Beta-blockers/Antidepressants)",
          "step1Duration": "Documented failure",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Chronic Migraine (G43.709): ≥15 HA days/month with ≥8 migrainous days for ≥3 months; Reauthorization requires documented benefit (typically >7 days/month reduction OR significant functional improvement - return to work/school)",
          "contraBypass": "Yes - oral preventive contraindications",
          "goldCardAvail": "NO - H.4616 pending",
          "goldCardThresh": null,
          "policyId": "MHDL Table 14",
          "sourceDoc": "Massachusetts_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        }
      },
      "MA-MAC-NGS": {
        "Neurotoxins": {
          "state": "MA",
          "payerName": "National Government Services",
          "payerType": "Medicare MAC",
          "lob": "Part B",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "Per LCD L33646/DL39909; G43.709/719 codes; JZ modifier if no waste",
          "step1Duration": "Adequate trial",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "155 units/12 weeks",
          "contraBypass": "Yes",
          "goldCardAvail": "N/A (Federal)",
          "goldCardThresh": null,
          "policyId": "LCD DL39909",
          "sourceDoc": "Massachusetts_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        }
      },
      "CA-MCD-LACAREHEALTH": {
        "CGRP mAbs (IV)": {
          "state": "CA",
          "payerName": "L.A. Care Health Plan",
          "payerType": "Medicaid MCO",
          "lob": "Medical Benefit",
          "drugClass": "CGRP mAbs (IV)",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "≥8 weeks each",
          "step2Req": "≥2 SC CGRPs",
          "step2Duration": "Documented failure",
          "quantityLimit": "Medical Benefit; high scrutiny; must show inability to self-inject",
          "contraBypass": "Yes - inability to self-inject documented; SB 530 network adequacy (15 miles/30 min or 15 days)",
          "goldCardAvail": "No (Medicaid)",
          "goldCardThresh": null,
          "policyId": "L.A. Care Medical Benefit",
          "sourceDoc": "California_2026_PA_Audit",
          "denialCode": "DENY-QL-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "CA-COM-HNET": {
        "Gepants (Acute)": {
          "state": "CA",
          "payerName": "Health Net",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 triptans per Centene clinical guidelines",
          "step1Duration": "≥4 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Pharmacy carved to Medi-Cal Rx for Medicaid; commercial follows Centene guidelines",
          "contraBypass": "Yes - CV contraindication",
          "goldCardAvail": "SB 306 Data Calibration 2026",
          "goldCardThresh": "Exemptions effective 2028",
          "policyId": "Health Net Formulary",
          "sourceDoc": "California_2026_PA_Audit",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "CGRP mAbs (SC)": {
          "state": "CA",
          "payerName": "Health Net",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes per Centene guidelines",
          "step1Duration": "≥8 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Centene clinical criteria apply",
          "contraBypass": "Yes - teratogenic; CV contraindication",
          "goldCardAvail": "SB 306 Data Calibration 2026",
          "goldCardThresh": "Exemptions effective 2028",
          "policyId": "Health Net CGRP Policy",
          "sourceDoc": "California_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "CA-PARTB-NORIDIAN": {
        "CGRP mAbs (IV)": {
          "state": "CA",
          "payerName": "Noridian Healthcare Solutions",
          "payerType": "Medicare MAC",
          "lob": "Part B",
          "drugClass": "CGRP mAbs (IV)",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "Per LCD requirements",
          "step1Duration": "Documented",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "J3032; Chronic Migraine; Medical Benefit; Jurisdiction E (CA/NV/HI)",
          "contraBypass": "Yes - inability to self-inject; documented in chart",
          "goldCardAvail": "No (Federal Medicare)",
          "goldCardThresh": null,
          "policyId": "LCD DL39909",
          "sourceDoc": "California_2026_PA_Audit",
          "denialCode": "DENY-QL-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "KS-COM-BLUEKC": {
        "Gepants (Acute)": {
          "state": "KS",
          "payerName": "Blue Cross Blue Shield of Kansas City",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 generic triptans",
          "step1Duration": "≥2 acute episodes",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Nurtec 8/30d, Ubrelvy 10/30d",
          "contraBypass": "Yes - CV contraindication",
          "goldCardAvail": "No",
          "goldCardThresh": null,
          "policyId": "BLUEKC-RX-2026",
          "sourceDoc": "Kansas_PA_Audit__Migraine_Drug_Defense",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "CGRP mAbs (SC)": {
          "state": "KS",
          "payerName": "Blue Cross Blue Shield Kansas City",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "Documented",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "⚠️ Ajovy EXCLUDED on Premium/Select formularies; forced switch to Aimovig/Emgality; Continuity of Care appeal for stable patients",
          "contraBypass": "Yes - stability (Continuity)",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "Blue KC Formulary",
          "sourceDoc": "Kansas_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Neurotoxins": {
          "state": "KS",
          "payerName": "Blue Cross Blue Shield of Kansas City",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "≥8 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "155 units/12 weeks standard",
          "contraBypass": "Yes - oral contraindications",
          "goldCardAvail": "No",
          "goldCardThresh": null,
          "policyId": "BLUEKC-BOTOX-2026",
          "sourceDoc": "Kansas_PA_Audit__Migraine_Drug_Defense",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        },
        "Gepants (Preventive)": {
          "state": "KS",
          "payerName": "Blue KC",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Preventive)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "Per UHC step therapy protocol",
          "step1Duration": "≥8 weeks",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "30 tabs/30 days",
          "contraBypass": "Yes - standard",
          "goldCardAvail": "No",
          "goldCardThresh": null,
          "policyId": null,
          "sourceDoc": "Kansas_PA_Audit_Migraine_Drug_Defense.docx",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "UHC step therapy reference"
        }
      },
      "KS-PARTB-WPSGHA": {
        "Neurotoxins": {
          "state": "KS",
          "payerName": "WPS Government Health Administrators",
          "payerType": "Medicare MAC",
          "lob": "Part B",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "Traditional preventive methods proven unsuccessful",
          "step1Duration": "Documented in chart",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "155-200 units/12 weeks per LCD",
          "contraBypass": "Yes - documented in medical record",
          "goldCardAvail": "N/A - Federal Medicare",
          "goldCardThresh": null,
          "policyId": "LCD DL39909",
          "sourceDoc": "Q1-2026-Policy-Refresh",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "LCD L39909 mandates highly specific documentation detailing the exact conservative methods completed and clinical assessment of intolerance or inadequate response."
        }
      },
      "MN-COM-MEDICA": {
        "Gepants (Acute)": {
          "state": "MN",
          "payerName": "Medica",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 triptans per formulary",
          "step1Duration": "≥4 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Non-Preferred or PA required; transitional friction with UCare legacy members Q1 2026",
          "contraBypass": "Yes - CV contraindication; vascular risk factors",
          "goldCardAvail": "MN §62M.07 Platinum Card",
          "goldCardThresh": "Chronic condition auth does not expire",
          "policyId": "Medica Formulary 2026",
          "sourceDoc": "Minnesota_2026_PA_Audit",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "CGRP mAbs (SC)": {
          "state": "MN",
          "payerName": "Medica",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "≥8 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Aimovig/Ajovy/Emgality preferred; acquired UCare business - watch for adjudication conflicts; 30.76% rate increase driving stricter UM",
          "contraBypass": "Yes - intolerance documentation; teratogenic bypass",
          "goldCardAvail": "MN §62M.07 Platinum Card",
          "goldCardThresh": "Chronic condition auth does not expire",
          "policyId": "Medica CGRP Policy",
          "sourceDoc": "Minnesota_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Neurotoxins": {
          "state": "MN",
          "payerName": "Medica",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "≥8 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Chronic Migraine (≥15 days/mo); Medical Benefit; stricter UM due to premium pressures",
          "contraBypass": "Prohibits concurrent use of Botox with any CGRP inhibitor for chronic migraine prophylaxis",
          "goldCardAvail": "MN §62M.07 Platinum Card",
          "goldCardThresh": "Chronic condition auth does not expire",
          "policyId": "Medica Botox Policy",
          "sourceDoc": "Q1-2026-Policy-Refresh",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        }
      },
      "MN-MCD-UCARE": {
        "CGRP mAbs (SC)": {
          "state": "MN",
          "payerName": "UCare",
          "payerType": "Medicaid MCO",
          "lob": "Medicaid",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes per DHS Uniform PDL,≥8 weeks each",
          "step1Duration": null,
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "⚠️ TRANSITIONING TO MEDICA - legacy runoff; Aimovig/Ajovy/Emgality preferred on PDL; Vyepti non-preferred; §62M.17 60-day continuity applies",
          "contraBypass": "Yes - intolerance (cognitive slowing, fatigue) bypasses trial duration",
          "goldCardAvail": "Legacy - transitioning",
          "goldCardThresh": null,
          "policyId": "DHS Uniform PDL",
          "sourceDoc": "Minnesota_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Neurotoxins": {
          "state": "MN",
          "payerName": "UCare",
          "payerType": "Medicaid MCO",
          "lob": "Medicaid",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "≥8 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "⚠️ TRANSITIONING - D-SNP discontinued; members moving to new plans; 60-day continuity protections apply",
          "contraBypass": "Yes - oral preventive contraindications",
          "goldCardAvail": "Legacy - transitioning",
          "goldCardThresh": null,
          "policyId": "DHS Uniform PDL",
          "sourceDoc": "Minnesota_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        }
      },
      "MN-MCD-BLUEPLUS": {
        "Gepants (Acute)": {
          "state": "MN",
          "payerName": "Blue Plus",
          "payerType": "Medicaid MCO",
          "lob": "Medicaid",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 triptans per DHS Uniform PDL",
          "step1Duration": "≥4 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Non-Preferred; Nurtec/Ubrelvy require PA",
          "contraBypass": "Yes - vascular risk factors; CV contraindication",
          "goldCardAvail": "MN §62M.07 Platinum Card",
          "goldCardThresh": "Chronic condition auth does not expire",
          "policyId": "DHS Uniform PDL 2026",
          "sourceDoc": "Minnesota_2026_PA_Audit",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "CGRP mAbs (SC)": {
          "state": "MN",
          "payerName": "Blue Plus",
          "payerType": "Medicaid MCO",
          "lob": "Medicaid",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes (Beta-blockers, Antidepressants, Anticonvulsants)",
          "step1Duration": "≥8 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Aimovig/Ajovy/Emgality preferred per DHS PDL; Vyepti non-preferred (higher PA hurdles); expanded Ramsey/Scott counties",
          "contraBypass": "Yes - intolerance documentation sufficient to bypass trial duration",
          "goldCardAvail": "MN §62M.07 Platinum Card",
          "goldCardThresh": "Chronic condition auth does not expire",
          "policyId": "DHS Uniform PDL 2026",
          "sourceDoc": "Minnesota_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Neurotoxins": {
          "state": "MN",
          "payerName": "Blue Plus",
          "payerType": "Medicaid MCO",
          "lob": "Medicaid",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes per DHS criteria",
          "step1Duration": "≥8 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Chronic Migraine (≥15 days/mo); dual therapy with CGRP requires medical necessity appeal",
          "contraBypass": "Yes - oral preventive contraindications/intolerances",
          "goldCardAvail": "MN §62M.07 Platinum Card",
          "goldCardThresh": "Chronic condition auth does not expire",
          "policyId": "DHS Uniform PDL/Blue Plus Policy",
          "sourceDoc": "Minnesota_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        }
      },
      "MN-PARTB-NGS": {
        "CGRP mAbs (IV)": {
          "state": "MN",
          "payerName": "National Government Services",
          "payerType": "Medicare MAC",
          "lob": "Part B",
          "drugClass": "CGRP mAbs (IV)",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "Per LCD requirements; SC CGRP failures",
          "step1Duration": "Documented",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "J3032; Chronic Migraine diagnosis; Medical Benefit",
          "contraBypass": "Yes - inability to self-inject; SC intolerance",
          "goldCardAvail": "No (Federal Medicare)",
          "goldCardThresh": null,
          "policyId": "LCD DL39909",
          "sourceDoc": "Minnesota_2026_PA_Audit",
          "denialCode": "DENY-STEP-005",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "TX-MCD-UHC": {
        "Gepants (Acute)": {
          "state": "TX",
          "payerName": "UnitedHealthcare Community Plan",
          "payerType": "Medicaid MCO",
          "lob": "Medicaid",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 preferred triptans per Texas VDP (Frovatriptan often preferred)",
          "step1Duration": "≥4 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": ">9 tabs/month requires Clinical PA proving no MOH",
          "contraBypass": "Yes - CV contraindication; MOH exclusion documentation required",
          "goldCardAvail": "No (Medicaid excluded HB 3459)",
          "goldCardThresh": null,
          "policyId": "Texas VDP Clinical Edit",
          "sourceDoc": "Texas_2026_PA_Audit",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "CGRP mAbs (SC)": {
          "state": "TX",
          "payerName": "UnitedHealthcare Community Plan",
          "payerType": "Medicaid MCO",
          "lob": "Medicaid",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes per VDP",
          "step1Duration": "≥8 weeks each",
          "step2Req": "PDL Prior Authorization if Non-Preferred",
          "step2Duration": "Must fail Preferred agents on state list",
          "quantityLimit": "VDP quantity limits; Non-Preferred Drug Request required",
          "contraBypass": "Yes - standard contraindication language",
          "goldCardAvail": "No (Medicaid excluded HB 3459)",
          "goldCardThresh": null,
          "policyId": "Texas VDP PDL PA Form",
          "sourceDoc": "Texas_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "TX-COM-AMBET": {
        "Gepants (Acute)": {
          "state": "TX",
          "payerName": "Ambetter from Superior",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 triptans or preferred formulary alternatives",
          "step1Duration": "≥4 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Qulipta/Nurtec Non-Preferred; Non-Preferred Drug Request required",
          "contraBypass": "Yes - CV contraindication",
          "goldCardAvail": "Yes (HB 3459/HB 3812)",
          "goldCardThresh": "TDI regulated fully insured plans",
          "policyId": "Ambetter Formulary 2026",
          "sourceDoc": "Texas_2026_PA_Audit",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "CGRP mAbs (SC)": {
          "state": "TX",
          "payerName": "Ambetter from Superior",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes or generic failures",
          "step1Duration": "≥8 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Non-Preferred Drug Request for restricted agents",
          "contraBypass": "Yes - teratogenic; CV contraindication",
          "goldCardAvail": "Yes (HB 3459/HB 3812)",
          "goldCardThresh": "TDI regulated fully insured plans",
          "policyId": "Ambetter HB3459 FAQ",
          "sourceDoc": "Texas_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "TX-PARTB-NOVITAS": {
        "CGRP mAbs (IV)": {
          "state": "TX",
          "payerName": "Novitas Solutions",
          "payerType": "Medicare MAC",
          "lob": "Part B",
          "drugClass": "CGRP mAbs (IV)",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "Per LCD requirements",
          "step1Duration": "Documented",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "J3032; Chronic Migraine diagnosis required; Medical Benefit",
          "contraBypass": "Yes - inability to self-inject documented",
          "goldCardAvail": "No (Federal Medicare exempt)",
          "goldCardThresh": null,
          "policyId": "LCD DL39909",
          "sourceDoc": "Texas_2026_PA_Audit",
          "denialCode": "DENY-QL-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "NY-COM-AETNA": {
        "Gepants (Acute)": {
          "state": "NY",
          "payerName": "Aetna New York",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 triptans - strict enforcement",
          "step1Duration": "≥4 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Ubrelvy/Nurtec 16 tabs/30d (stricter than some payers); aggressive MOH denial if >10 days/month acute med use; must document 'not attributable to MOH' + concurrent preventive therapy",
          "contraBypass": "Yes - CV contraindication; must explicitly document NO medication overuse headache",
          "goldCardAvail": "Pending (S7470)",
          "goldCardThresh": "N/A - pending legislation",
          "policyId": "Aetna Policy 3481-E",
          "sourceDoc": "New_York_2026_PA_Audit",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "CGRP mAbs (SC)": {
          "state": "NY",
          "payerName": "Aetna New York",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "≥8 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Aimovig PREFERRED; standard CGRP criteria",
          "contraBypass": "Yes - teratogenic; CV contraindication",
          "goldCardAvail": "Pending (S7470)",
          "goldCardThresh": "N/A - pending legislation",
          "policyId": "Aetna CGRP Policy",
          "sourceDoc": "New_York_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Neurotoxins": {
          "state": "NY",
          "payerName": "Aetna New York",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "≥8 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Chronic Migraine; 50% REDUCTION required for reauth; Medical Benefit",
          "contraBypass": "Yes - documented failures",
          "goldCardAvail": "Pending (S7470)",
          "goldCardThresh": "N/A - pending legislation",
          "policyId": "Aetna Botox Policy",
          "sourceDoc": "New_York_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        },
        "CGRP mAbs (IV)": {
          "state": "NY",
          "payerName": "Aetna New York",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (IV)",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥3 months preventive treatment failure",
          "step1Duration": "Documented",
          "step2Req": "≥2 SC CGRPs (Aimovig/Emgality)",
          "step2Duration": "Failure required per CPB 0970",
          "quantityLimit": "J3032; Non-Preferred; requires oral + SC CGRP failures before IV option; bioavailability argument for GI stasis/malabsorption patients",
          "contraBypass": "Yes - severe GI stasis/malabsorption (100% bioavailability argument); SC injection failures/intolerance",
          "goldCardAvail": "Pending (S7470)",
          "goldCardThresh": "N/A - pending legislation",
          "policyId": "Aetna CPB 0970",
          "sourceDoc": "New_York_2026_PA_Audit",
          "denialCode": "DENY-STEP-005",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "NY-PARTB-NGS": {
        "Neurotoxins": {
          "state": "NY",
          "payerName": "National Government Services (NGS)",
          "payerType": "Medicare MAC",
          "lob": "Part B",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "Traditional preventive methods proven unsuccessful (implies ≥2 oral classes)",
          "step1Duration": "Documented in chart",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "155-200 units/12 weeks; LCD L33646; STRICT ICD-10: G43.701/G43.709/G43.711/G43.719 ONLY (NO R51 or episodic G43.0-/G43.1-); ≥15 HA days/mo for ≥3 months; ≥4 hours duration; document specific muscles injected + dosage per site; 12-week interval STRICT (10-11 weeks = denial); JW/JZ modifiers MANDATORY",
          "contraBypass": "Yes - documented in medical record with specific diagnosis codes",
          "goldCardAvail": "No - Federal Medicare",
          "goldCardThresh": null,
          "policyId": "LCD L33646",
          "sourceDoc": "Q1-2026-Policy-Refresh",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "Managed under LCD L39832; requires documented functional improvement for continuation"
        },
        "CGRP mAbs (IV)": {
          "state": "NY",
          "payerName": "National Government Services (NGS)",
          "payerType": "Medicare MAC",
          "lob": "Part B",
          "drugClass": "CGRP mAbs (IV)",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "Per LCD requirements",
          "step1Duration": "Documented",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "J3032; Chronic Migraine; Medical Benefit; Jurisdiction K (NY/CT/MA/ME/NH/RI/VT)",
          "contraBypass": "Yes - inability to self-inject; documented in chart",
          "goldCardAvail": "No - Federal Medicare",
          "goldCardThresh": null,
          "policyId": "LCD L33646/DL39909",
          "sourceDoc": "New_York_2026_PA_Audit",
          "denialCode": "DENY-QL-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "NY-COM-ECELBCBS": {
        "Gepants (Acute)": {
          "state": "NY",
          "payerName": "Excellus BlueCross BlueShield",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 triptans",
          "step1Duration": "≥4 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Regional Upstate NY BCBS; Headache Disorders pharmacy policy",
          "contraBypass": "Yes - CV contraindication",
          "goldCardAvail": "Pending (S7470)",
          "goldCardThresh": "N/A - pending legislation",
          "policyId": "Excellus Headache Disorders Policy",
          "sourceDoc": "New_York_2026_PA_Audit",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "CGRP mAbs (SC)": {
          "state": "NY",
          "payerName": "Excellus BlueCross BlueShield",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "≥8 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Regional formulary; 2026 Part D $2000 OOP cap applies to Medicare Advantage plans",
          "contraBypass": "Yes - teratogenic; CV contraindication",
          "goldCardAvail": "Pending (S7470)",
          "goldCardThresh": "N/A - pending legislation",
          "policyId": "Excellus CGRP Policy",
          "sourceDoc": "New_York_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Neurotoxins": {
          "state": "NY",
          "payerName": "Excellus BlueCross BlueShield",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "≥8 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Chronic Migraine; Medical Benefit",
          "contraBypass": "Yes - documented failures",
          "goldCardAvail": "Pending (S7470)",
          "goldCardThresh": "N/A - pending legislation",
          "policyId": "Excellus Botox Policy",
          "sourceDoc": "New_York_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        }
      },
      "FL-PARTB-FCSO": {
        "Neurotoxins": {
          "state": "FL",
          "payerName": "First Coast Service Options (FCSO)",
          "payerType": "Medicare MAC",
          "lob": "Part B",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "Medical Necessity documentation (implies ≥2 oral classes per SOC)",
          "step1Duration": "Documented in chart",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "LCD L33274; Chronic Migraine (G43.7x) ONLY - Episodic explicitly NOT covered; 12-week interval STRICT (10-11 weeks = denial); max 200 units; JW modifier wastage monitored; 2026: CPT 64615 requires PRE-SERVICE PA in HOPD/ASC settings (Prior Authorization Demonstration expansion); injection site map required; % reduction in HA days for continuation",
          "contraBypass": "Yes - documented in medical record",
          "goldCardAvail": "No - Federal Medicare (preempts SB 7016)",
          "goldCardThresh": null,
          "policyId": "LCD L33274",
          "sourceDoc": "Q1-2026-Policy-Refresh",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "Updated Botulinum Toxin LCD requiring aggressive documentation and peer-reviewed literature for dosages exceeding FDA-labeled maximums per affected muscle, strict exclusion of cosmetic utilization, and mandatory ABN/GA modifier usage for claim protection."
        },
        "CGRP mAbs (IV)": {
          "state": "FL",
          "payerName": "First Coast Service Options (FCSO)",
          "payerType": "Medicare MAC",
          "lob": "Part B",
          "drugClass": "CGRP mAbs (IV)",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "Medical Necessity (Migraine diagnosis)",
          "step1Duration": "Documented",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "J3032; Original Medicare does NOT force Part D step therapy (no SC CGRP failure required unlike MA plans); can administer as first-line biologic if Migraine dx documented",
          "contraBypass": "Yes - no SC step required for Original Medicare (FFS) unlike MA plans",
          "goldCardAvail": "No - Federal Medicare",
          "goldCardThresh": null,
          "policyId": "LCD L33274 / Medical Necessity",
          "sourceDoc": "Florida_2026_PA_Audit",
          "denialCode": "DENY-QL-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "FL-COM-AMBET": {
        "Gepants (Acute)": {
          "state": "FL",
          "payerName": "Ambetter from Sunshine Health",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 triptans",
          "step1Duration": "≥4 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Exchange plan - follows Centene commercial guidelines (more restrictive than AHCA PDL)",
          "contraBypass": "Yes - CV contraindication",
          "goldCardAvail": "Yes (SB 7016)",
          "goldCardThresh": "Active",
          "policyId": "Ambetter Formulary",
          "sourceDoc": "Florida_2026_PA_Audit",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "CGRP mAbs (SC)": {
          "state": "FL",
          "payerName": "Ambetter from Sunshine Health",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "≥8 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Separate from Medicaid - follows Centene commercial formulary",
          "contraBypass": "Yes - teratogenic; CV contraindication",
          "goldCardAvail": "Yes (SB 7016)",
          "goldCardThresh": "Active",
          "policyId": "Ambetter CGRP Policy",
          "sourceDoc": "Florida_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "PA-MCD-FFS": {
        "Gepants (Acute)": {
          "state": "PA",
          "payerName": "Pennsylvania Medicaid FFS",
          "payerType": "Medicaid FFS",
          "lob": "Medicaid Pharmacy",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "2 Triptans",
          "step1Duration": null,
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": null,
          "contraBypass": "Yes - contraindication to vasoconstrictive agents (uncontrolled HTN, ischemic heart disease, PVD, CVD, hemiplegic/basilar migraine)",
          "goldCardAvail": "N/A - Medicaid FFS",
          "goldCardThresh": null,
          "policyId": "PA DHS Statewide PDL",
          "sourceDoc": "Q1-2026-Policy-Refresh",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "CGRP mAbs (SC)": {
          "state": "PA",
          "payerName": "Pennsylvania Medicaid FFS",
          "payerType": "Medicaid FFS",
          "lob": "Medicaid Pharmacy",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 distinct classes of conventional oral preventives (beta-blockers: propranolol/metoprolol, anticonvulsants: topiramate/valproic acid, TCAs: amitriptyline/nortriptyline) at therapeutic doses",
          "step1Duration": "≥8 weeks each unless discontinued early for documented adverse effects; failure = <50% reduction in monthly migraine days OR intolerable adverse effects",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Most stringent in PA; PA DHS PDL governs",
          "contraBypass": "Yes - documented contraindications to conventional preventives",
          "goldCardAvail": "N/A - Medicaid FFS",
          "goldCardThresh": null,
          "policyId": "PA DHS Statewide PDL",
          "sourceDoc": "Pennsylvania_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Neurotoxins": {
          "state": "PA",
          "payerName": "Pennsylvania Medicaid FFS",
          "payerType": "Medicaid FFS",
          "lob": "Medical Benefit",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventives (falls under medical benefit not PDL),≥8 weeks each",
          "step1Duration": null,
          "step2Req": null,
          "step2Duration": "Chronic Migraine per ICHD-3 (≥15 HA days/mo for ≥3 consecutive months",
          "quantityLimit": " ≥8 days with migraine features); headache diary or clinical note required",
          "contraBypass": "Yes - oral preventive contraindications",
          "goldCardAvail": "N/A - Medicaid FFS",
          "goldCardThresh": null,
          "policyId": "PA DHS Medical Policy",
          "sourceDoc": "Pennsylvania_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        }
      },
      "IL-COM-AETNA": {
        "Gepants (Acute)": {
          "state": "IL",
          "payerName": "Aetna Illinois",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 triptans",
          "step1Duration": "≥4 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Standard QL; CPB criteria",
          "contraBypass": "Yes - CV contraindication",
          "goldCardAvail": "Public Act 103-0593 (July 1 2026)",
          "goldCardThresh": "≥90% on ≥50 PAs",
          "policyId": "Aetna CPB 0970",
          "sourceDoc": "Illinois_2026_PA_Audit_Strategy",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "CGRP mAbs (SC)": {
          "state": "IL",
          "payerName": "Aetna Illinois",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "⚠️ ≥2 distinct oral preventive classes for ≥3 MONTHS each - LONGEST trial duration (vs 8 weeks for competitors)",
          "step1Duration": "≥3 months each (STRICTEST - common cause of 'insufficient duration of trial' denial)",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "CPB 0970 - strictest standard; Site of Care restrictions for Vyepti",
          "contraBypass": "Yes - documented intolerances; teratogenic bypass; CV contraindication",
          "goldCardAvail": "Public Act 103-0593 (July 1 2026)",
          "goldCardThresh": "≥90% on ≥50 PAs",
          "policyId": "Aetna CPB 0970",
          "sourceDoc": "Illinois_2026_PA_Audit_Strategy",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Neurotoxins": {
          "state": "IL",
          "payerName": "Aetna Illinois",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "≥3 months each (consistent with CPB 0970)",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Chronic Migraine; CPB criteria",
          "contraBypass": "Yes - oral preventive contraindications",
          "goldCardAvail": "Public Act 103-0593 (July 1 2026)",
          "goldCardThresh": "≥90% on ≥50 PAs",
          "policyId": "Aetna Botox Policy",
          "sourceDoc": "Illinois_2026_PA_Audit_Strategy",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        },
        "CGRP mAbs (IV)": {
          "state": "IL",
          "payerName": "Aetna Illinois",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (IV)",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "≥3 months each",
          "step2Req": "Site of Care restriction - HOPD non-preferred",
          "step2Duration": "Documented",
          "quantityLimit": "J3032; Site of Care: Home Infusion/freestanding preferred; HOPD exception requires medical necessity (difficult venous access, anaphylaxis history)",
          "contraBypass": "Yes - inability to self-inject; GI intolerance",
          "goldCardAvail": "Public Act 103-0593 (July 1 2026)",
          "goldCardThresh": "≥90% on ≥50 PAs",
          "policyId": "Aetna CPB 0970",
          "sourceDoc": "Illinois_2026_PA_Audit_Strategy",
          "denialCode": "DENY-STEP-005",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "IL-PARTB-NGS": {
        "Neurotoxins": {
          "state": "IL",
          "payerName": "National Government Services (NGS)",
          "payerType": "Medicare MAC",
          "lob": "Part B",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "Same as IL-MAC-NGS — updated Botox LCD effective February 22, 2026. Illinois Part B covered under WPS GHA jurisdiction. Tightened chronic migraine documentation requirements apply. Medical benefit.",
          "step1Duration": "≥2-3 months each class",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "LCD DL39909 (eff 1/1/2026); Chronic Migraine ONLY (≥15 HA days/mo for >3 mo with ≥8 migraine days) - Episodic NOT covered; must document 'migraine days' vs 'headache days' explicitly; ICD-10: G43.709/G43.719 (avoid R51.9); frequency STRICT 12 weeks (84 days) - claims <84 days = automated denial; STOPPING RULE after 2 cycles (6 months) - must show 'significant decrease' with quantified improvement (e.g., '20 days/mo → 9 days/mo')",
          "contraBypass": "Yes - documented 3-class failures with specific adverse events",
          "goldCardAvail": "No - Federal Medicare",
          "goldCardThresh": null,
          "policyId": "LCD DL39909",
          "sourceDoc": "Q1-2026-Policy-Refresh",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series.",
          "siteOfCare": "Same as IL-MAC-NGS — updated Botox LCD effective February 22, 2026. Illinois Part B covered under WPS GHA jurisdiction. Tightened chronic migraine documentation requirements apply. Medical benefit."
        },
        "CGRP mAbs (IV)": {
          "state": "IL",
          "payerName": "National Government Services (NGS)",
          "payerType": "Medicare MAC",
          "lob": "Part B",
          "drugClass": "CGRP mAbs (IV)",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "≥8 weeks each",
          "step2Req": "Usually requires failure of ≥1 self-injected CGRP unless needle phobia/cognitive impairment documented",
          "step2Duration": "Documented",
          "quantityLimit": "J3032; LCD DL39909 covers BOTH Episodic and Chronic Migraine (unlike Botox); bypass SC step with 'needle phobia' or 'inability to self-administer'",
          "contraBypass": "Yes - needle phobia; cognitive impairment; inability to self-administer",
          "goldCardAvail": "No - Federal Medicare",
          "goldCardThresh": null,
          "policyId": "LCD DL39909",
          "sourceDoc": "Illinois_2026_PA_Audit_Strategy",
          "denialCode": "DENY-QL-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "IL-MCD-ILBCBS": {
        "Gepants (Acute)": {
          "state": "IL",
          "payerName": "Blue Cross Community Health Plan (BCCHP)",
          "payerType": "Medicaid MCO",
          "lob": "Medicaid",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 triptans per HFS PDL",
          "step1Duration": "≥4 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Specific quantity limits on triptans (differs from commercial); follows HFS PDL",
          "contraBypass": "Yes - CV contraindication",
          "goldCardAvail": "Public Act 103-0593 (July 1 2026)",
          "goldCardThresh": "≥90% on ≥50 PAs",
          "policyId": "HFS PDL",
          "sourceDoc": "Illinois_2026_PA_Audit_Strategy",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "CGRP mAbs (SC)": {
          "state": "IL",
          "payerName": "Blue Cross Community Health Plan (BCCHP)",
          "payerType": "Medicaid MCO",
          "lob": "Medicaid",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes per HFS PDL",
          "step1Duration": "≥8 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Follows HFS PDL; different from commercial BCBSIL",
          "contraBypass": "Yes - teratogenic; CV contraindication",
          "goldCardAvail": "Public Act 103-0593 (July 1 2026)",
          "goldCardThresh": "≥90% on ≥50 PAs",
          "policyId": "HFS PDL",
          "sourceDoc": "Illinois_2026_PA_Audit_Strategy",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Neurotoxins": {
          "state": "IL",
          "payerName": "Blue Cross Community Health Plan (BCCHP)",
          "payerType": "Medicaid MCO",
          "lob": "Medicaid",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "≥8 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Chronic Migraine; follows HFS PDL for Medicaid",
          "contraBypass": "Yes - oral preventive contraindications",
          "goldCardAvail": "Public Act 103-0593 (July 1 2026)",
          "goldCardThresh": "≥90% on ≥50 PAs",
          "policyId": "HFS PDL / BCCHP Medical",
          "sourceDoc": "Illinois_2026_PA_Audit_Strategy",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        }
      },
      "OH-MCD-GAINWELL": {
        "Gepants (Acute)": {
          "state": "OH",
          "payerName": "Ohio Medicaid (ODM/Gainwell)",
          "payerType": "Medicaid SPBM",
          "lob": "Medicaid Pharmacy",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 preferred triptans (Sumatriptan tab/nasal/inj, Rizatriptan tab/ODT, Naratriptan, Zolmitriptan tab)",
          "step1Duration": "Adequate trial",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Nurtec ODT: 18 tabs/30d preventive; 8 tabs/30d acute; Ubrelvy: 10 tabs/30d (up to 16 with med necessity); UPDL applies to ALL MCOs (CareSource/Buckeye/Molina/UHC)",
          "contraBypass": "Yes - CV disease (code I10 on PA request) waives triptan trial; 'Contraindication to vasoconstrictive agents'",
          "goldCardAvail": "HB 130 (Pending)",
          "goldCardThresh": null,
          "policyId": "Ohio UPDL",
          "sourceDoc": "Ohio_2026_PA_Audit_Strategy",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "CGRP mAbs (SC)": {
          "state": "OH",
          "payerName": "Ohio Medicaid (ODM/Gainwell)",
          "payerType": "Medicaid SPBM",
          "lob": "Medicaid Pharmacy",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "30 days trial of at least two preferred controller migraine drugs (or 1 if established on serotonergic medication)",
          "step1Duration": "≥30 days each class",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Emgality 120mg PREFERRED; Aimovig 70/140mg PREFERRED; Ajovy NON-PREFERRED (requires Emgality/Aimovig failure); Qulipta requires oral failures + preferred injectable CGRP failure",
          "contraBypass": "Yes - document intolerance/contraindication: Topiramate (cognitive/nephrolithiasis/glaucoma); Beta-blockers (asthma/bradycardia/depression); TCAs (weight gain/sedation/serotonin risk)",
          "goldCardAvail": "HB 130 (Pending)",
          "goldCardThresh": null,
          "policyId": "Ohio UPDL",
          "sourceDoc": "Q1-2026-Policy-Refresh",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Gepants (Preventive)": {
          "state": "OH",
          "payerName": "Ohio Medicaid (ODM/Gainwell)",
          "payerType": "Medicaid SPBM",
          "lob": "Medicaid Pharmacy",
          "drugClass": "Gepants (Preventive)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥3 oral preventive classes per UPDL",
          "step1Duration": "≥30 days each",
          "step2Req": "Must fail preferred injectable CGRP (Emgality or Aimovig)",
          "step2Duration": "Documented failure",
          "quantityLimit": "Qulipta requires both oral AND injectable CGRP failure unless needle phobia documented",
          "contraBypass": "Yes - needle phobia; inability to self-inject",
          "goldCardAvail": "HB 130 (Pending)",
          "goldCardThresh": null,
          "policyId": "Ohio UPDL",
          "sourceDoc": "Ohio_2026_PA_Audit_Strategy",
          "denialCode": "DENY-QL-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "OH-PARTB-CGS": {
        "Neurotoxins": {
          "state": "OH",
          "payerName": "CGS Administrators",
          "payerType": "Medicare MAC",
          "lob": "Part B",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes (Beta-blockers, Anticonvulsants, TCAs)",
          "step1Duration": "≥2 months each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "LCD L33949/DL39909 (eff Feb 15 2026); Chronic Migraine ICHD-3 strict (≥15 HA days/mo, ≥8 migraine days, ≥3 months); ⚠️ STOPPED THERAPY RULE: reauth requires documented 'significant clinical response' after 2 cycles - quantified HA day reduction (e.g., 20→12) OR HIT-6 ≥5pt reduction OR MIDAS ≥30% reduction; 'Frequent migraines' = automatic denial",
          "contraBypass": "Yes - documented oral preventive failures with specific adverse events",
          "goldCardAvail": "No - Federal Medicare",
          "goldCardThresh": null,
          "policyId": "LCD L33949/DL39909",
          "sourceDoc": "Ohio_2026_PA_Audit_Strategy",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        },
        "CGRP mAbs (IV)": {
          "state": "OH",
          "payerName": "CGS Administrators",
          "payerType": "Medicare MAC",
          "lob": "Part B",
          "drugClass": "CGRP mAbs (IV)",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "Documented failure",
          "step2Req": "LCD does not mandate Botox/SC CGRP failure for Original Medicare (but MA plans may overlay)",
          "step2Duration": "Documented",
          "quantityLimit": "J3032; 100mg IV q3mo standard; ⚠️ 300mg ONLY if documented partial/inadequate response to 100mg (starting at 300mg = denial); Site of Care review - HOPD requires 'difficult IV access' or 'hypersensitivity requiring physician oversight'",
          "contraBypass": "Yes - needle phobia; inability to self-administer; difficult IV access",
          "goldCardAvail": "No - Federal Medicare",
          "goldCardThresh": null,
          "policyId": "LCD DL39909",
          "sourceDoc": "Ohio_2026_PA_Audit_Strategy",
          "denialCode": "DENY-QL-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "OH-COM-MEDMUTUAL": {
        "Gepants (Acute)": {
          "state": "OH",
          "payerName": "Medical Mutual of Ohio",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 triptans (Sumatriptan, Rizatriptan, Eletriptan)",
          "step1Duration": "Documented failure",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Tier 2 (Preferred Brand) on most plans; Tier 3 on 'Basic' plans; Ubrelvy 10 tabs/30d; Nurtec 8 tabs/30d acute",
          "contraBypass": "Yes - 'Vasoconstrictor Contraindication' highly effective with MMO/ESI",
          "goldCardAvail": "Investigating",
          "goldCardThresh": null,
          "policyId": "MMO/ESI Formulary",
          "sourceDoc": "Q1-2026-Policy-Refresh",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "Combination therapy with Ubrelvy or Zavzpret is expressly prohibited. Initial approval 90 days; extended 365 days."
        },
        "CGRP mAbs (SC)": {
          "state": "OH",
          "payerName": "Medical Mutual of Ohio",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥1-2 oral preventive classes (slightly more lenient than Medicaid),≥2 months each; strictly enforced electronically",
          "step1Duration": null,
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Emgality/Aimovig PREFERRED; Ajovy NON-PREFERRED (requires step through BOTH Emgality AND Aimovig unless latex allergy with Aimovig autoinjector)",
          "contraBypass": "Yes - teratogenic; CV contraindication; documented intolerance (bradycardia, cognitive dysfunction)",
          "goldCardAvail": "Investigating",
          "goldCardThresh": null,
          "policyId": "MMO Medical Policy",
          "sourceDoc": "Ohio_2026_PA_Audit_Strategy",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Neurotoxins": {
          "state": "OH",
          "payerName": "Medical Mutual of Ohio",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "≥2 months each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "eviCore/Cohere for PA (digital portal REQUIRED - fax rejected/delayed); Chronic Migraine (≥15 days/mo)",
          "contraBypass": "Yes - oral preventive contraindications",
          "goldCardAvail": "Investigating",
          "goldCardThresh": null,
          "policyId": "MMO Medical Policy",
          "sourceDoc": "Ohio_2026_PA_Audit_Strategy",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        },
        "CGRP mAbs (IV)": {
          "state": "OH",
          "payerName": "Medical Mutual of Ohio",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (IV)",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "≥2 months each",
          "step2Req": "Site of Care review",
          "step2Duration": "Documented",
          "quantityLimit": "J3032; Site of Care review applies",
          "contraBypass": "Yes - inability to self-inject; difficult IV access",
          "goldCardAvail": "Investigating",
          "goldCardThresh": null,
          "policyId": "MMO Medical Policy",
          "sourceDoc": "Ohio_2026_PA_Audit_Strategy",
          "denialCode": "DENY-QL-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "OH-MCD-BUCKEYE": {
        "Gepants (Acute)": {
          "state": "OH",
          "payerName": "Buckeye Health Plan",
          "payerType": "Medicaid MCO",
          "lob": "Medicaid Pharmacy",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 preferred triptans per UPDL",
          "step1Duration": "Per UPDL",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "UPDL criteria via Gainwell",
          "contraBypass": "Yes - CV contraindication per UPDL",
          "goldCardAvail": "HB 130 (Pending)",
          "goldCardThresh": null,
          "policyId": "Ohio UPDL",
          "sourceDoc": "Ohio_2026_PA_Audit_Strategy",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "CGRP mAbs (SC)": {
          "state": "OH",
          "payerName": "Buckeye Health Plan",
          "payerType": "Medicaid MCO",
          "lob": "Medicaid Pharmacy",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥3 oral preventive classes per UPDL",
          "step1Duration": "≥30 days each per UPDL",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "UPDL criteria via Gainwell",
          "contraBypass": "Yes - per UPDL criteria",
          "goldCardAvail": "HB 130 (Pending)",
          "goldCardThresh": null,
          "policyId": "Ohio UPDL",
          "sourceDoc": "Ohio_2026_PA_Audit_Strategy",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Neurotoxins": {
          "state": "OH",
          "payerName": "Buckeye Health Plan",
          "payerType": "Medicaid MCO",
          "lob": "Medical Benefit",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "≥2 months each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Medical benefit managed by MCO - 2 class standard",
          "contraBypass": "Yes - oral preventive contraindications",
          "goldCardAvail": "HB 130 (Pending)",
          "goldCardThresh": null,
          "policyId": "Buckeye Medical Policy",
          "sourceDoc": "Ohio_2026_PA_Audit_Strategy",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        }
      },
      "GA-MCD-DCH": {
        "Gepants (Acute)": {
          "state": "GA",
          "payerName": "Georgia Medicaid (DCH)",
          "payerType": "Medicaid Unified PDL",
          "lob": "Medicaid Pharmacy",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 preferred triptans (Sumatriptan, Rizatriptan)",
          "step1Duration": "Documented failure = 'inadequate response' or 'intolerance/contraindication' - NOT 'patient preference'",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Ubrelvy/Nurtec NON-PREFERRED; QL typically 8-16 doses/30 days; applies to ALL CMOs via Unified PDL",
          "contraBypass": "Yes - CV contraindication = 'Contraindication to vasoconstrictive agents'",
          "goldCardAvail": "SB 5 (CMOs) - July 1 2026",
          "goldCardThresh": "90% threshold",
          "policyId": "Georgia Unified PDL",
          "sourceDoc": "Georgia_2026_PA_Audit_Strategy",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "CGRP mAbs (SC)": {
          "state": "GA",
          "payerName": "Georgia Medicaid (DCH)",
          "payerType": "Medicaid Unified PDL",
          "lob": "Medicaid Pharmacy",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes (Beta-blockers: Propranolol/Metoprolol/Timolol, Anticonvulsants: Topiramate/Divalproex, Antidepressants: Amitriptyline/Venlafaxine),≥8-12 weeks each,N/A",
          "step1Duration": null,
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Aimovig/Emgality PREFERRED (Step 2 agents); Ajovy/Vyepti NON-PREFERRED",
          "contraBypass": "Yes - document specific intolerance (cognitive slowing, sedation, weight gain) OR contraindication (asthma precludes beta-blockers)",
          "goldCardAvail": "SB 5 (CMOs) - July 1 2026",
          "goldCardThresh": "90% threshold",
          "policyId": "Georgia Unified PDL",
          "sourceDoc": "Georgia_2026_PA_Audit_Strategy",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Neurotoxins": {
          "state": "GA",
          "payerName": "Georgia Medicaid (DCH)",
          "payerType": "Medicaid Unified PDL",
          "lob": "Medical Benefit",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "≥8 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Chronic Migraine (≥15 HA days/mo); headache logs required; medical benefit may vary slightly between CMOs and FFS",
          "contraBypass": "Yes - oral preventive contraindications",
          "goldCardAvail": "SB 5 (CMOs) - July 1 2026",
          "goldCardThresh": "90% threshold",
          "policyId": "Georgia Medicaid Medical",
          "sourceDoc": "Georgia_2026_PA_Audit_Strategy",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        },
        "CGRP mAbs (IV)": {
          "state": "GA",
          "payerName": "Georgia Medicaid (DCH)",
          "payerType": "Medicaid Unified PDL",
          "lob": "Medical Benefit",
          "drugClass": "CGRP mAbs (IV)",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "≥8 weeks each",
          "step2Req": "Fail preferred CGRP mAbs (Aimovig/Emgality)",
          "step2Duration": "Documented failure",
          "quantityLimit": "J3032; Medical Benefit; requires step through preferred SC CGRPs",
          "contraBypass": "Yes - needle phobia; physical disability preventing self-injection",
          "goldCardAvail": "SB 5 (CMOs) - July 1 2026",
          "goldCardThresh": "90% threshold",
          "policyId": "Georgia Medicaid Medical",
          "sourceDoc": "Georgia_2026_PA_Audit_Strategy",
          "denialCode": "DENY-QL-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "GA-MA-UHC": {
        "CGRP mAbs (IV)": {
          "state": "GA",
          "payerName": "UnitedHealthcare Georgia",
          "payerType": "Medicare Advantage",
          "lob": "Part B",
          "drugClass": "CGRP mAbs (IV)",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "≥8 weeks each",
          "step2Req": "⚠️ Part B Step Therapy (MA Plans): Must fail self-administered CGRP (Aimovig/Emgality) before Vyepti authorized",
          "step2Duration": "Documented SC CGRP failure",
          "quantityLimit": "J3032; Part B Step Therapy program explicitly lists Vyepti; bypass requires documented 'Physical inability to self-administer subcutaneous injections due to [needle phobia/arthritis/tremor]'",
          "contraBypass": "Yes - needle phobia; physical disability; arthritis; tremor; cognitive impairment",
          "goldCardAvail": "UHC National Gold Card",
          "goldCardThresh": "92% threshold on J3032",
          "policyId": "UHC Part B Step Therapy",
          "sourceDoc": "Georgia_2026_PA_Audit_Strategy",
          "denialCode": "DENY-QL-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "GA-PARTB-PALMETTO": {
        "CGRP mAbs (IV)": {
          "state": "GA",
          "payerName": "Palmetto GBA",
          "payerType": "Medicare MAC",
          "lob": "Part B",
          "drugClass": "CGRP mAbs (IV)",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "Fail standard care",
          "step1Duration": "Documented",
          "step2Req": "LCD does not mandate SC CGRP failure for Original Medicare but MA plans overlay steps",
          "step2Duration": "Documented",
          "quantityLimit": "J3032; Buy-and-bill ASP+6% (2% sequestration applies); no mandated step for Original Medicare but MA plans (UHC/Anthem) add SC CGRP requirement",
          "contraBypass": "Yes - needle phobia; inability to self-inject",
          "goldCardAvail": "No - Federal Medicare",
          "goldCardThresh": null,
          "policyId": "LCD L33458",
          "sourceDoc": "Georgia_2026_PA_Audit_Strategy",
          "denialCode": "DENY-QL-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "GA-COM-AMBET": {
        "Gepants (Acute)": {
          "state": "GA",
          "payerName": "Ambetter of Georgia",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 triptans",
          "step1Duration": "Documented failure",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Narrow network + highly restrictive formulary (low premium strategy); CGRP access heavily gated",
          "contraBypass": "Yes - CV contraindication",
          "goldCardAvail": "SB 5 - July 1 2026",
          "goldCardThresh": "90% threshold",
          "policyId": "Ambetter Formulary",
          "sourceDoc": "Georgia_2026_PA_Audit_Strategy",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "CGRP mAbs (SC)": {
          "state": "GA",
          "payerName": "Ambetter of Georgia",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "≥8-12 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Restrictive formulary; branded CGRPs gated behind multiple generic failures",
          "contraBypass": "Yes - teratogenic; CV contraindication; documented intolerance",
          "goldCardAvail": "SB 5 - July 1 2026",
          "goldCardThresh": "90% threshold",
          "policyId": "Ambetter CGRP Policy",
          "sourceDoc": "Georgia_2026_PA_Audit_Strategy",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "NC-MCD-DHB": {
        "Gepants (Acute)": {
          "state": "NC",
          "payerName": "NC Medicaid (DHB)",
          "payerType": "Medicaid Unified PDL",
          "lob": "Medicaid Pharmacy",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "\"≥2 preferred triptans (sumatriptan, rizatriptan, naratriptan); failure = lack of efficacy after treating ≥3 attacks OR intolerance/side effects\",Documented per definition,N/A",
          "step1Duration": null,
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Nurtec ODT 16 tabs/30d; Ubrelvy 16 tabs/30d; Zavzpret NON-PREFERRED requires triptan + oral gepant failure unless severe nausea/vomiting documented",
          "contraBypass": "Yes - CV contraindication (ischemic heart disease, uncontrolled HTN, cerebrovascular disease) = 'Contraindication to vasoconstrictive 5-HT1B/1D agonists'",
          "goldCardAvail": "HB 434 CARE FIRST Act - pending",
          "goldCardThresh": "80% threshold",
          "policyId": "NC Clinical Coverage Policy",
          "sourceDoc": "North_Carolina_2026_PA_Audit",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "CGRP mAbs (SC)": {
          "state": "NC",
          "payerName": "NC Medicaid (DHB)",
          "payerType": "Medicaid Unified PDL",
          "lob": "Medicaid Pharmacy",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 different oral prophylactic classes (Beta-blockers: propranolol/metoprolol, Antidepressants: amitriptyline/venlafaxine, Antiepileptics: topiramate/valproate, ACE/ARBs, CCBs)",
          "step1Duration": "≥2 months EACH (total 4+ months of failure)",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "PREFERRED: Aimovig, Ajovy, Emgality, Nurtec ODT (preventive), Qulipta; NON-PREFERRED: Vyepti (requires fail preferred mAbs + 'Medical Necessity' for infusion); MOH exclusion documentation REQUIRED - failing to document MOH ruled out = denial; pregnancy test at baseline for mAbs",
          "contraBypass": "Yes - teratogenic bypass for women of childbearing potential (avoid valproate/topiramate); intolerance documentation",
          "goldCardAvail": "HB 434 CARE FIRST Act - pending",
          "goldCardThresh": "80% threshold",
          "policyId": "NC Clinical Coverage Policy",
          "sourceDoc": "North_Carolina_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Neurotoxins": {
          "state": "NC",
          "payerName": "NC Medicaid (DHB)",
          "payerType": "Medicaid Unified PDL",
          "lob": "Medical Benefit",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "\"⚠️ ≥3 different drug classes (Beta-blockers, CCBs, TCAs, Anticonvulsants) - STRICTER than commercial 2-class requirement\",≥3 MONTHS each class (vs 2 months for CGRPs)",
          "step1Duration": null,
          "step2Req": null,
          "step2Duration": "Clinical Coverage Policy 1B; Chronic Migraine ONLY (≥15 HA days/mo",
          "quantityLimit": " ≥8 migrainous days) for ≥3 months; Age ≥18; ⚠️ REAUTH requires reduction of ≥6 headache days/month from baseline - quantitative metric absolute (subjective 'improvement' insufficient)",
          "contraBypass": "Yes - oral preventive contraindications documented",
          "goldCardAvail": "HB 434 CARE FIRST Act - pending",
          "goldCardThresh": "80% threshold",
          "policyId": "NC Medicaid CCP 1B",
          "sourceDoc": "North_Carolina_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        },
        "CGRP mAbs (IV)": {
          "state": "NC",
          "payerName": "NC Medicaid (DHB)",
          "payerType": "Medicaid Unified PDL",
          "lob": "Medical Benefit",
          "drugClass": "CGRP mAbs (IV)",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral prophylactic classes",
          "step1Duration": "≥2 months each",
          "step2Req": "Must fail ≥1 preferred self-injectable CGRP mAb",
          "step2Duration": "Documented failure",
          "quantityLimit": "NON-PREFERRED; requires 'Medical Necessity' for infusion setting: needle phobia; physical inability to self-inject; failure of subcutaneous absorption",
          "contraBypass": "Yes - needle phobia; physical inability; absorption failure",
          "goldCardAvail": "HB 434 CARE FIRST Act - pending",
          "goldCardThresh": "80% threshold",
          "policyId": "NC Medicaid Medical",
          "sourceDoc": "North_Carolina_2026_PA_Audit",
          "denialCode": "DENY-QL-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "NC-COM-CIGNA": {
        "Gepants (Acute)": {
          "state": "NC",
          "payerName": "Cigna Healthcare NC",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 triptans",
          "step1Duration": "Documented failure",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Standard criteria; Zavzpret requires triptan + oral gepant (Ubrelvy/Nurtec) failure due to cost differentials",
          "contraBypass": "Yes - CV contraindication",
          "goldCardAvail": "HB 434 - pending",
          "goldCardThresh": "80% threshold",
          "policyId": "Cigna/ESI Formulary",
          "sourceDoc": "North_Carolina_2026_PA_Audit",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "CGRP mAbs (SC)": {
          "state": "NC",
          "payerName": "Cigna Healthcare NC",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "≥8 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "⚠️ EMGALITY = primary preferred agent; Cigna frequently mandates Emgality trial BEFORE authorizing Aimovig or Ajovy (viewed as non-preferred within class)",
          "contraBypass": "Yes - teratogenic; CV contraindication; documented intolerance",
          "goldCardAvail": "HB 434 - pending",
          "goldCardThresh": "80% threshold",
          "policyId": "Cigna CGRP Policy",
          "sourceDoc": "North_Carolina_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": "8.0",
          "episodicNotes": "Cigna: Standard episodic (4-7d) = triptan failure only for acute; High-freq episodic (≥8d) = 1 oral class for CGRP; Chronic (≥15d) = 2 oral classes. MIDAS ≥11 required for all preventives."
        },
        "Neurotoxins": {
          "state": "NC",
          "payerName": "Cigna Healthcare NC",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "≥8 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Chronic Migraine; standard criteria",
          "contraBypass": "Yes - oral preventive contraindications",
          "goldCardAvail": "HB 434 - pending",
          "goldCardThresh": "80% threshold",
          "policyId": "Cigna Botox Policy",
          "sourceDoc": "North_Carolina_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        }
      },
      "NC-COM-AMBET": {
        "Gepants (Acute)": {
          "state": "NC",
          "payerName": "Ambetter of North Carolina",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 triptans",
          "step1Duration": "Documented failure",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Standard criteria; narrow network - OON PA requests summarily denied in HMO structures",
          "contraBypass": "Yes - CV contraindication",
          "goldCardAvail": "HB 434 - pending",
          "goldCardThresh": "80% threshold",
          "policyId": "Ambetter Formulary",
          "sourceDoc": "North_Carolina_2026_PA_Audit",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "CGRP mAbs (SC)": {
          "state": "NC",
          "payerName": "Ambetter of North Carolina",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "≥8 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Formulary shifts frequently (rebate-driven); Ajovy/Emgality rotate as preferred; check current formulary",
          "contraBypass": "Yes - teratogenic; CV contraindication",
          "goldCardAvail": "HB 434 - pending",
          "goldCardThresh": "80% threshold",
          "policyId": "Ambetter CGRP Policy",
          "sourceDoc": "North_Carolina_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Neurotoxins": {
          "state": "NC",
          "payerName": "Ambetter of North Carolina",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "≥8 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "⚠️ Requires specific documentation regarding MOH (medication overuse headache) evaluation prior to approval",
          "contraBypass": "Yes - oral preventive contraindications",
          "goldCardAvail": "HB 434 - pending",
          "goldCardThresh": "80% threshold",
          "policyId": "Ambetter Botox Policy",
          "sourceDoc": "North_Carolina_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        }
      },
      "NC-PARTB-PALMETTO": {
        "Neurotoxins": {
          "state": "NC",
          "payerName": "Palmetto GBA (NC)",
          "payerType": "Medicare MAC",
          "lob": "Part B",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "Fail 2-3 standard therapies",
          "step1Duration": "Documented in medical record",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "LCD L33458 (outgoing) → DL39909 (eff Feb 15 2026) = CRITICAL TRANSITION; ⚠️ DL39909 MANDATES PREEMPT PROTOCOL: 155 units across 31 FIXED sites; anatomical restrictions (frontalis/corrugator/procerus/occipitalis/temporalis/trapezius/cervical paraspinal ONLY - masseter denied); ICD-10: G43.709/G43.719 required; notes must document specific muscles + dosage per site; JW modifier for waste mandatory (200u vial - 155u used = 45u waste); JZ if zero waste",
          "contraBypass": "Yes - documented standard therapy failures with adverse events",
          "goldCardAvail": "No - Federal Medicare",
          "goldCardThresh": null,
          "policyId": "LCD L33458 → DL39909",
          "sourceDoc": "Q1-2026-Policy-Refresh",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "Concurrent use with CGRP requires documented reduction in migraine days but continued need for prevention. Frequency of injections limited to 12 weeks."
        },
        "CGRP mAbs (IV)": {
          "state": "NC",
          "payerName": "Palmetto GBA (NC)",
          "payerType": "Medicare MAC",
          "lob": "Part B",
          "drugClass": "CGRP mAbs (IV)",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "Fail standard care",
          "step1Duration": "Documented",
          "step2Req": "LCD does not mandate SC CGRP failure for Original Medicare",
          "step2Duration": "Documented",
          "quantityLimit": "J3032; Part B buy-and-bill; covered for chronic migraine",
          "contraBypass": "Yes - needle phobia; inability to self-inject",
          "goldCardAvail": "No - Federal Medicare",
          "goldCardThresh": null,
          "policyId": "LCD L33458",
          "sourceDoc": "North_Carolina_2026_PA_Audit",
          "denialCode": "DENY-QL-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "NC-MCD-HEALTHYBLUE": {
        "Gepants (Acute)": {
          "state": "NC",
          "payerName": "Healthy Blue NC",
          "payerType": "Medicaid MCO",
          "lob": "Medicaid",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 preferred triptans per NC Medicaid PDL",
          "step1Duration": "Per state policy",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Follows NC Medicaid Clinical Coverage Policies - cannot be stricter",
          "contraBypass": "Yes - CV contraindication per state policy",
          "goldCardAvail": "HB 434 - pending",
          "goldCardThresh": "80% threshold",
          "policyId": "NC Medicaid PDL",
          "sourceDoc": "North_Carolina_2026_PA_Audit",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "CGRP mAbs (SC)": {
          "state": "NC",
          "payerName": "Healthy Blue NC",
          "payerType": "Medicaid MCO",
          "lob": "Medicaid",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral prophylactic classes per NC Medicaid policy",
          "step1Duration": "≥2 months each per state policy",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Follows NC Medicaid Clinical Coverage Policies - cannot be stricter",
          "contraBypass": "Yes - per state policy criteria",
          "goldCardAvail": "HB 434 - pending",
          "goldCardThresh": "80% threshold",
          "policyId": "NC Medicaid PDL",
          "sourceDoc": "North_Carolina_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Neurotoxins": {
          "state": "NC",
          "payerName": "Healthy Blue NC",
          "payerType": "Medicaid MCO",
          "lob": "Medical Benefit",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥3 drug classes per NC Medicaid policy",
          "step1Duration": "≥3 months each per state policy",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Follows NC Medicaid Clinical Coverage Policy 1B - cannot be stricter",
          "contraBypass": "Yes - per state policy criteria",
          "goldCardAvail": "HB 434 - pending",
          "goldCardThresh": "80% threshold",
          "policyId": "NC Medicaid CCP 1B",
          "sourceDoc": "North_Carolina_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        }
      },
      "NJ-COM-AMERI": {
        "Gepants (Acute)": {
          "state": "NJ",
          "payerName": "AmeriHealth NJ",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 triptans",
          "step1Duration": "Documented failure",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "'Select' formulary value-driven; aggressively steers to generics; often requires P2P for Tier 3 exceptions",
          "contraBypass": "Yes - CV contraindication",
          "goldCardAvail": "A1825 applies",
          "goldCardThresh": "72h response",
          "policyId": "AmeriHealth Gepant Policy",
          "sourceDoc": "New_Jersey_2026_PA_Audit",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "CGRP mAbs (SC)": {
          "state": "NJ",
          "payerName": "AmeriHealth NJ",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes (Select formulary strictness)",
          "step1Duration": "≥8 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "High pressure to use generics; use A1825 to override",
          "contraBypass": "Yes - teratogenic; CV contraindication; documented intolerance",
          "goldCardAvail": "A1825 applies",
          "goldCardThresh": "72h response",
          "policyId": "AmeriHealth CGRP Policy",
          "sourceDoc": "New_Jersey_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Neurotoxins": {
          "state": "NJ",
          "payerName": "AmeriHealth NJ",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "≥8 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Standard Chronic Migraine criteria",
          "contraBypass": "Yes - oral preventive contraindications",
          "goldCardAvail": "A1825 applies",
          "goldCardThresh": "72h response",
          "policyId": "AmeriHealth Botox Policy",
          "sourceDoc": "New_Jersey_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        }
      },
      "NJ-COM-OSCAR": {
        "Gepants (Acute)": {
          "state": "NJ",
          "payerName": "Oscar Health NJ",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 triptans",
          "step1Duration": "Documented failure",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Digital/portal-based PA; favors clean data entry over narrative letters",
          "contraBypass": "Yes - CV contraindication",
          "goldCardAvail": "A1825 applies",
          "goldCardThresh": "72h response",
          "policyId": "Oscar Formulary",
          "sourceDoc": "New_Jersey_2026_PA_Audit",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "CGRP mAbs (SC)": {
          "state": "NJ",
          "payerName": "Oscar Health NJ",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "≥8 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Digital submission preferred",
          "contraBypass": "Yes - teratogenic; CV contraindication",
          "goldCardAvail": "A1825 applies",
          "goldCardThresh": "72h response",
          "policyId": "Oscar CGRP Policy",
          "sourceDoc": "New_Jersey_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "NJ-MCD-HORIZON": {
        "Gepants (Acute)": {
          "state": "NJ",
          "payerName": "Horizon NJ Health",
          "payerType": "Medicaid MCO",
          "lob": "Medicaid",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 triptans per NJ FamilyCare PDL",
          "step1Duration": "Per state policy",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Uses specific state-mandated fax forms; follows NJ FamilyCare PDL",
          "contraBypass": "Yes - CV contraindication per PDL",
          "goldCardAvail": "A1825 applies",
          "goldCardThresh": "72h response",
          "policyId": "NJ FamilyCare PDL",
          "sourceDoc": "New_Jersey_2026_PA_Audit",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "CGRP mAbs (SC)": {
          "state": "NJ",
          "payerName": "Horizon NJ Health",
          "payerType": "Medicaid MCO",
          "lob": "Medicaid",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes per NJ FamilyCare",
          "step1Duration": "Per state policy",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Strictly adheres to NJ FamilyCare PDL; requires MOH assessment",
          "contraBypass": "Yes - per state criteria",
          "goldCardAvail": "A1825 applies",
          "goldCardThresh": "72h response",
          "policyId": "NJ FamilyCare PDL",
          "sourceDoc": "New_Jersey_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Neurotoxins": {
          "state": "NJ",
          "payerName": "Horizon NJ Health",
          "payerType": "Medicaid MCO",
          "lob": "Medical Benefit",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes per NJ FamilyCare",
          "step1Duration": "Per state policy",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Follows NJ FamilyCare criteria; requires MOH assessment",
          "contraBypass": "Yes - per state criteria",
          "goldCardAvail": "A1825 applies",
          "goldCardThresh": "72h response",
          "policyId": "NJ FamilyCare Medical",
          "sourceDoc": "New_Jersey_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        }
      },
      "NJ-PARTB-NOVITAS": {
        "CGRP mAbs (IV)": {
          "state": "NJ",
          "payerName": "Novitas Solutions",
          "payerType": "Medicare MAC",
          "lob": "Part B",
          "drugClass": "CGRP mAbs (IV)",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "WISeR PILOT: Pre-Service PA MANDATORY; fail ≥2 oral preventives",
          "step1Duration": "Documented with dates/reasons",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "LCD L39909; J3032; ⚠️ Pre-Service PA required - do NOT inject without Auth #; Chronic or Episodic Migraine; same HIT-6/MIDAS documentation requirements",
          "contraBypass": "Yes - documented oral failures; needle phobia; inability to self-inject",
          "goldCardAvail": "WISeR Gold Card",
          "goldCardThresh": "High approval rate",
          "policyId": "LCD L39909",
          "sourceDoc": "New_Jersey_2026_PA_Audit",
          "denialCode": "DENY-QL-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "VA-COM-SENTARA": {
        "Gepants (Acute)": {
          "state": "VA",
          "payerName": "Sentara Health Plans",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 triptans; failure defined as '≥2 attacks treated unsuccessfully'",
          "step1Duration": "Documented per definition",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Nurtec ODT 8 tabs/30d; Ubrelvy 10 tabs/30d; Zavzpret 6 sprays/30d; ⚠️ QLE for 16 tabs requires MOH risk documentation - 'Gepants do not carry same MOH risk as triptans/opioids (FDA approved for preventive EOD dosing)'",
          "contraBypass": "Yes - CV contraindication; gastroparesis for Zavzpret",
          "goldCardAvail": "HB 2099 - Data Collection 2026",
          "goldCardThresh": "90% threshold",
          "policyId": "Sentara Drug Auth Forms",
          "sourceDoc": "Virginia_2026_PA_Audit",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "CGRP mAbs (SC)": {
          "state": "VA",
          "payerName": "Sentara Health Plans",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥1 medication from ≥2 different prophylactic classes (Anticonvulsants, Beta-blockers, Antidepressants)",
          "step1Duration": "⚠️ ≥2 MONTHS each (longer than Anthem 1 month)",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "PREFERRED: Aimovig, Ajovy, Emgality; NON-PREFERRED: Vyepti; ⚠️ 'Early Termination' Strategy: AE at Day 5 = trial failed (don't need full 60 days)",
          "contraBypass": "Yes - teratogenic; CV contraindication; documented intolerance (sedation/hypotension/paresthesia)",
          "goldCardAvail": "HB 2099 - Data Collection 2026",
          "goldCardThresh": "90% threshold",
          "policyId": "Sentara CGRP Policy",
          "sourceDoc": "Virginia_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Gepants (Preventive)": {
          "state": "VA",
          "payerName": "Sentara",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Preventive)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventives",
          "step1Duration": "≥8 weeks",
          "step2Req": "Fail 1 injectable CGRP (Aimovig/Ajovy/Emgality)",
          "step2Duration": null,
          "quantityLimit": "30 tabs/30 days",
          "contraBypass": "Yes - needle phobia; injection impossible",
          "goldCardAvail": "No",
          "goldCardThresh": null,
          "policyId": "IP0377",
          "sourceDoc": "Virginia_2026_PA_Audit.md",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "Preferred but requires mAb step edit"
        },
        "Neurotoxins": {
          "state": "VA",
          "payerName": "Sentara Health Plans",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "≥2 months each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Chronic Migraine (≥15 days); standard criteria",
          "contraBypass": "Yes - oral preventive contraindications",
          "goldCardAvail": "HB 2099 - Data Collection 2026",
          "goldCardThresh": "90% threshold",
          "policyId": "Sentara Botox Policy",
          "sourceDoc": "Virginia_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        }
      },
      "VA-COM-CIGNA": {
        "Gepants (Acute)": {
          "state": "VA",
          "payerName": "Cigna Healthcare Virginia",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥1-2 triptans",
          "step1Duration": "Documented failure",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Standard criteria",
          "contraBypass": "Yes - CV contraindication",
          "goldCardAvail": "HB 2099 - Data Collection 2026",
          "goldCardThresh": "90% threshold",
          "policyId": "Cigna IP0050",
          "sourceDoc": "Virginia_2026_PA_Audit",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "CGRP mAbs (SC)": {
          "state": "VA",
          "payerName": "Cigna Healthcare Virginia",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes; ⚠️ Every PA MUST include: 'Current Baseline: [X] Migraine Days Per Month' - vague 'frequent headaches' = auto-denial",
          "step1Duration": "⚠️ ≥3 MONTHS each (LONGEST)",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "PREFERRED: Aimovig, Ajovy; NON-PREFERRED: Emgality (requires step through Aimovig/Ajovy); ⚠️ 'Lack of Information' trap - document specific baseline headache days",
          "contraBypass": "Yes - teratogenic; CV contraindication; documented intolerance",
          "goldCardAvail": "HB 2099 - Data Collection 2026",
          "goldCardThresh": "90% threshold",
          "policyId": "Cigna IP0050",
          "sourceDoc": "Virginia_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": "8.0",
          "episodicNotes": "Cigna: Standard episodic (4-7d) = triptan failure only for acute; High-freq episodic (≥8d) = 1 oral class for CGRP; Chronic (≥15d) = 2 oral classes. MIDAS ≥11 required for all preventives."
        },
        "Gepants (Preventive)": {
          "state": "VA",
          "payerName": "Cigna Healthcare Virginia",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Preventive)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥4 migraine days/month; ≥2 oral classes",
          "step1Duration": "≥3 months each",
          "step2Req": "No injectable CGRP step required (more accessible than Sentara)",
          "step2Duration": null,
          "quantityLimit": "Renewal requires 'significant clinical benefit' - if days unchanged but severity improved, document: 'Patient reports reduction in severity and improved function (MIDAS score reduction)'",
          "contraBypass": "Yes - needle phobia; documented intolerance",
          "goldCardAvail": "HB 2099 - Data Collection 2026",
          "goldCardThresh": "90% threshold",
          "policyId": "Cigna IP0377",
          "sourceDoc": "Virginia_2026_PA_Audit",
          "denialCode": "DENY-STEP-005",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": "8.0",
          "episodicNotes": "Cigna: Standard episodic (4-7d) = triptan failure only for acute; High-freq episodic (≥8d) = 1 oral class for CGRP; Chronic (≥15d) = 2 oral classes. MIDAS ≥11 required for all preventives."
        },
        "Neurotoxins": {
          "state": "VA",
          "payerName": "Cigna Healthcare Virginia",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "≥3 months each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Chronic Migraine (≥15 days); longest trial duration requirement",
          "contraBypass": "Yes - oral preventive contraindications",
          "goldCardAvail": "HB 2099 - Data Collection 2026",
          "goldCardThresh": "90% threshold",
          "policyId": "Cigna Botox Policy",
          "sourceDoc": "Virginia_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        }
      },
      "VA-MCD-CARDINAL": {
        "Gepants (Acute)": {
          "state": "VA",
          "payerName": "Cardinal Care (VA Medicaid)",
          "payerType": "Medicaid Unified",
          "lob": "Medicaid",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 triptans per Common Core Formulary",
          "step1Duration": "Per CCF",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "PREFERRED per CCF: Nurtec ODT, Ubrelvy; NON-PREFERRED: Reyvow, Zavzpret; MCO denials citing 'triptan failure required' when already failed = appeal via CCF contract compliance",
          "contraBypass": "Yes - CV contraindication per CCF",
          "goldCardAvail": "N/A - Medicaid",
          "goldCardThresh": null,
          "policyId": "Common Core Formulary 2026",
          "sourceDoc": "Virginia_2026_PA_Audit",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "CGRP mAbs (SC)": {
          "state": "VA",
          "payerName": "Cardinal Care (VA Medicaid)",
          "payerType": "Medicaid Unified",
          "lob": "Medicaid",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes per Common Core Formulary",
          "step1Duration": "Per CCF",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "PREFERRED per CCF: Aimovig, Ajovy, Emgality; Qulipta 'Preferred (Step Edit Required)'; NON-PREFERRED: Vyepti; ⚠️ MCOs cannot restrict Preferred PDL drugs if DMAS criteria met - appeal: 'Denial of Preferred PDL agent when criteria met is violation of MCO contract with DMAS'",
          "contraBypass": "Yes - teratogenic; CV contraindication per CCF",
          "goldCardAvail": "N/A - Medicaid",
          "goldCardThresh": null,
          "policyId": "Common Core Formulary 2026",
          "sourceDoc": "Virginia_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Neurotoxins": {
          "state": "VA",
          "payerName": "Cardinal Care (VA Medicaid)",
          "payerType": "Medicaid Unified",
          "lob": "Medical Benefit",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes per CCF",
          "step1Duration": "Per CCF",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Chronic Migraine; follows CCF criteria",
          "contraBypass": "Yes - oral preventive contraindications per CCF",
          "goldCardAvail": "N/A - Medicaid",
          "goldCardThresh": null,
          "policyId": "Common Core Formulary 2026",
          "sourceDoc": "Virginia_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        }
      },
      "VA-PARTB-PALMETTO": {
        "Neurotoxins": {
          "state": "VA",
          "payerName": "Palmetto GBA (VA)",
          "payerType": "Medicare MAC",
          "lob": "Part B",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "Same as VA-MAC-PALMETTO — updated Botox LCD effective February 22, 2026",
          "step1Duration": "Same as VA-MAC-PALMETTO — updated Botox LCD effective February 22, 2026",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "LCD DL39909 effective Feb 15 2026; ⚠️ OBJECTIVE SCALING REQUIRED - notes saying 'patient doing well' = recoupment/denial; HIT-6 or MIDAS score MANDATORY at every visit (e.g., 'Pre-treatment HIT-6: 68. Current HIT-6: 54. Patient demonstrates functional improvement.')",
          "contraBypass": "Yes - documented oral failures with adverse events",
          "goldCardAvail": "No - Federal Medicare",
          "goldCardThresh": null,
          "policyId": "LCD DL39909",
          "sourceDoc": "Q1-2026-Policy-Refresh",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        },
        "CGRP mAbs (IV)": {
          "state": "VA",
          "payerName": "Palmetto GBA (VA)",
          "payerType": "Medicare MAC",
          "lob": "Part B",
          "drugClass": "CGRP mAbs (IV)",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "Fail standard care",
          "step1Duration": "Documented",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "J3032; ⚠️ Site of service scrutiny - HOPD faces higher scrutiny; justify: 'Patient is high-risk for infusion reaction and requires hospital-level monitoring'",
          "contraBypass": "Yes - inability to self-inject; infusion reaction risk",
          "goldCardAvail": "No - Federal Medicare",
          "goldCardThresh": null,
          "policyId": "LCD DL39909",
          "sourceDoc": "Virginia_2026_PA_Audit",
          "denialCode": "DENY-QL-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "WA-MCD-APPLE": {
        "Gepants (Acute)": {
          "state": "WA",
          "payerName": "Washington Apple Health (Medicaid)",
          "payerType": "Medicaid Unified",
          "lob": "Medicaid",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 different preferred triptans (Sumatriptan, Rizatriptan, Naratriptan, Zolmitriptan)",
          "step1Duration": "Documented failure/intolerance",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "NON-PREFERRED: Ubrelvy, Nurtec ODT, Reyvow, Zavzpret; QL 8-16 doses/30d depending on MCO overlay",
          "contraBypass": "Yes - CV contraindication (triptans are vasoconstrictive and contraindicated per FDA labeling); 'CGRP antagonists are the ONLY medically appropriate acute therapy' - triggers Contraindication exception in PA algorithm",
          "goldCardAvail": "NO - SB 5395 FAILED",
          "goldCardThresh": null,
          "policyId": "HCA Policy 67.70.10",
          "sourceDoc": "Washington_State_PA_Audit_2026",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "CGRP mAbs (SC)": {
          "state": "WA",
          "payerName": "Washington Apple Health (Medicaid)",
          "payerType": "Medicaid Unified",
          "lob": "Medicaid",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 different categories of oral prophylactics (Beta-blockers, Antidepressants, Anticonvulsants)",
          "step1Duration": "≥2 MONTHS each",
          "step2Req": "To access Aimovig/Vyepti: must fail BOTH Emgality AND Ajovy",
          "step2Duration": "Documented failure",
          "quantityLimit": "PREFERRED: Emgality, Ajovy; NON-PREFERRED: Aimovig, Vyepti; Qulipta/Nurtec preventive = non-preferred or require injectable failure first",
          "contraBypass": "Yes - teratogenicity bypass for women of childbearing potential (Topiramate/Valproate contraindicated); asthma/COPD bypass for beta-blockers; obesity bypass for Valproate (weight gain)",
          "goldCardAvail": "NO - SB 5395 FAILED",
          "goldCardThresh": null,
          "policyId": "HCA Policy 67.70.10",
          "sourceDoc": "Washington_State_PA_Audit_2026",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Neurotoxins": {
          "state": "WA",
          "payerName": "Washington Apple Health (Medicaid)",
          "payerType": "Medicaid Unified",
          "lob": "Medical Benefit",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "Documented failure",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Chronic Migraine (>15 days/mo) STRICT; ⚠️ Dual Therapy (Botox+CGRP) historically DENIED - appeal requires 'Refractory Chronic Migraine' + AHS 2024 Consensus citing synergistic mechanisms: 'Patient achieved partial response (30% reduction) with Botox but remains disabled with >8 migraine days/month'",
          "contraBypass": "Yes - oral preventive contraindications",
          "goldCardAvail": "NO - SB 5395 FAILED",
          "goldCardThresh": null,
          "policyId": "MCO Medical Review",
          "sourceDoc": "Washington_State_PA_Audit_2026",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        }
      },
      "WA-COM-PREMBC": {
        "Gepants (Acute)": {
          "state": "WA",
          "payerName": "Premera Blue Cross WA",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥1 triptan (MORE LENIENT than Medicaid/others)",
          "step1Duration": "Documented failure",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Ubrelvy/Nurtec = Tier 2 or 3; ⚠️ MOH EXCLUSION REMOVED - can prescribe gepants to patients detoxing from analgesic overuse ('Gepants lack MOH risk')",
          "contraBypass": "Yes - CV contraindication; MOH patients now eligible",
          "goldCardAvail": "NO - SB 5395 FAILED",
          "goldCardThresh": null,
          "policyId": "Premera 5.01.503",
          "sourceDoc": "Washington_State_PA_Audit_2026",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "CGRP mAbs (SC)": {
          "state": "WA",
          "payerName": "Premera Blue Cross WA",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 distinct categories oral prophylactics (Beta-blocker, TCA, Anticonvulsant)",
          "step1Duration": "Documented failure",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "PREFERRED: Emgality, Ajovy; Aimovig often NON-PREFERRED; ⚠️ Adolescent pathway (6-17) for Qulipta/Ajovy - fail 2 pediatric-appropriate preventives (Topiramate, Amitriptyline) - formal pathway many payers deny as 'experimental'",
          "contraBypass": "Yes - teratogenic; CV contraindication; documented intolerance",
          "goldCardAvail": "NO - SB 5395 FAILED",
          "goldCardThresh": null,
          "policyId": "Premera 5.01.584",
          "sourceDoc": "Washington_State_PA_Audit_2026",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Neurotoxins": {
          "state": "WA",
          "payerName": "Premera Blue Cross WA",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "Documented failure",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Chronic Migraine (>15 days); Reauthorization requires documented reduction ('50% reduction in headache days' or 'clinically meaningful improvement in function')",
          "contraBypass": "Yes - oral preventive contraindications",
          "goldCardAvail": "NO - SB 5395 FAILED",
          "goldCardThresh": null,
          "policyId": "Premera 5.01.512",
          "sourceDoc": "Washington_State_PA_Audit_2026",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        }
      },
      "WA-COM-KAISER": {
        "Gepants (Acute)": {
          "state": "WA",
          "payerName": "Kaiser Permanente Washington",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 triptans",
          "step1Duration": "Documented failure",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "RESTRICTED to Neurology specialty prescribers; PCPs blocked without e-consult/formal referral",
          "contraBypass": "Yes - CV contraindication",
          "goldCardAvail": "NO - SB 5395 FAILED",
          "goldCardThresh": null,
          "policyId": "Kaiser Clinical Review",
          "sourceDoc": "Washington_State_PA_Audit_2026",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "CGRP mAbs (SC)": {
          "state": "WA",
          "payerName": "Kaiser Permanente Washington",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "⚠️ MOST RESTRICTIVE: ≥3 oral preventive classes (Beta-blocker + TCA + Anticonvulsant) - EXCEEDS AHS 2-step standard",
          "step1Duration": "Documented failure all 3 classes",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "CGRPs in Tier 4/5 (Specialty) = significant coinsurance; ⚠️ Best strategy for Kaiser = External Review (IRO) citing 'Standard of Care Discrepancy' - AHS 2024 recommends CGRPs as first-line or after 1 failure; Kaiser's 3-failure requirement causes 'undue suffering and functional impairment'",
          "contraBypass": "Yes - teratogenic; CV contraindication; documented intolerance (use IRO argument)",
          "goldCardAvail": "NO - SB 5395 FAILED",
          "goldCardThresh": null,
          "policyId": "Kaiser Clinical Review",
          "sourceDoc": "Washington_State_PA_Audit_2026",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Neurotoxins": {
          "state": "WA",
          "payerName": "Kaiser Permanente Washington",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "⚠️ ≥3 oral preventive classes (strictest in state)",
          "step1Duration": "Documented failure all 3 classes",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Chronic Migraine (>15 days); ⚠️ Must be administered within Kaiser facilities - external referrals almost never approved; appeal via IRO if needed",
          "contraBypass": "Yes - oral preventive contraindications; IRO for external referral",
          "goldCardAvail": "NO - SB 5395 FAILED",
          "goldCardThresh": null,
          "policyId": "Kaiser Clinical Review",
          "sourceDoc": "Washington_State_PA_Audit_2026",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        }
      },
      "WA-PARTB-NORIDIAN": {
        "CGRP mAbs (IV)": {
          "state": "WA",
          "payerName": "Noridian Healthcare Solutions",
          "payerType": "Medicare MAC",
          "lob": "Part B",
          "drugClass": "CGRP mAbs (IV)",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes (for MA plans)",
          "step1Req": "Medicare FFS = no strict step therapy traditionally; ⚠️ MA plans (UHC/Humana) CAN and DO apply step therapy requiring failure of Part D options before Part B Vyepti",
          "step1Duration": "Per MA plan policy",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "J3032; Chronic or Episodic; ensure ICD-10 aligns with chronic criteria if treating chronic patient; ⚠️ Part D $2,100 Cap Impact: once beneficiary spends $2,100, cost drops to $0 for remainder of year - re-evaluate Medicare patients who discontinued CGRPs due to cost",
          "contraBypass": "Yes - inability to self-inject",
          "goldCardAvail": "No - Federal Medicare",
          "goldCardThresh": null,
          "policyId": "LCD L35172",
          "sourceDoc": "Washington_State_PA_Audit_2026",
          "denialCode": "DENY-QL-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "MA-COM-POINT32": {
        "Gepants (Acute)": {
          "state": "MA",
          "payerName": "Point32Health (Harvard Pilgrim/Tufts)",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 triptans per MNG",
          "step1Duration": "Documented failure",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Standard criteria via InterQual + internal MNGs",
          "contraBypass": "Yes - CV contraindication",
          "goldCardAvail": "NO - H.4616 pending",
          "goldCardThresh": null,
          "policyId": "Point32Health MNG",
          "sourceDoc": "Massachusetts_2026_PA_Audit",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "CGRP mAbs (SC)": {
          "state": "MA",
          "payerName": "Point32Health (Harvard Pilgrim/Tufts)",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 prophylactic classes (Beta-blockers/TCA-SNRI/Anticonvulsants) per MNG",
          "step1Duration": "Documented failure",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "⚠️ AJOVY EXCLUSION JAN 1 2026 - moved to NON-FORMULARY; PREFERRED: Emgality, Aimovig; stable Ajovy patients face POS rejections or Tier 4/5 copays; file 'Continuity of Care' or 'Medical Necessity' exception NOW using 'Non-Medical Switching' argument: 'Switching risks immunogenicity (anti-drug antibodies) and loss of disease control; AHS advises against switching stable patients for non-medical reasons'",
          "contraBypass": "Yes - teratogenic; CV contraindication; Non-Medical Switching defense for stable Ajovy patients",
          "goldCardAvail": "NO - H.4616 pending",
          "goldCardThresh": null,
          "policyId": "Point32Health MNG",
          "sourceDoc": "Massachusetts_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Neurotoxins": {
          "state": "MA",
          "payerName": "Point32Health (Harvard Pilgrim/Tufts)",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "⚠️ HIGHER BAR: ≥3 prophylactic medications from 2 different classes (stricter than MassHealth's 2 classes)",
          "step1Duration": "Documented failure",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Chronic Migraine diagnosis",
          "contraBypass": "Yes - oral preventive contraindications",
          "goldCardAvail": "NO - H.4616 pending",
          "goldCardThresh": null,
          "policyId": "Point32Health MNG",
          "sourceDoc": "Massachusetts_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        }
      },
      "MA-MCD-MASSBRIGHAM": {
        "CGRP mAbs (SC)": {
          "state": "MA",
          "payerName": "Mass General Brigham Health Plan",
          "payerType": "Commercial/Medicaid",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "Per MassHealth UPPL for Medicaid products; internal criteria for commercial/Medicare",
          "step1Duration": "Per product line",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "PREFERRED: Aimovig, Emgality; aligns with UPPL for Medicaid; 90-day PA honor for plan transitions (from Tufts SCO)",
          "contraBypass": "Yes - teratogenic; CV contraindication",
          "goldCardAvail": "N/A - Mixed",
          "goldCardThresh": null,
          "policyId": "MGBHP Formulary",
          "sourceDoc": "Massachusetts_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Neurotoxins": {
          "state": "MA",
          "payerName": "Mass General Brigham Health Plan",
          "payerType": "Commercial/Medicaid",
          "lob": "Medical Benefit",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "Per MassHealth UPPL for Medicaid; internal criteria for commercial",
          "step1Duration": "Per product line",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "⚠️ Dysport/Xeomin designated as preferred neurotoxins; Botox may require trial of preferred toxin for overlapping indications - BUT for Chronic Migraine Botox often retains exclusivity (specific FDA indication); watch for administrative friction",
          "contraBypass": "Yes - oral preventive contraindications; specific FDA indication defense",
          "goldCardAvail": "N/A - Mixed",
          "goldCardThresh": null,
          "policyId": "MGBHP Formulary",
          "sourceDoc": "Massachusetts_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        }
      },
      "MA-PARTB-NGS": {
        "Neurotoxins": {
          "state": "MA",
          "payerName": "National Government Services (NGS)",
          "payerType": "Medicare MAC",
          "lob": "Part B",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "Standard care failures (oral preventives implied); ⚠️ LCD DL39909 mandates OBJECTIVE SCALES (MIDAS/HIT-6) at every treatment cycle; 'patient feels better' = INSUFFICIENT",
          "step1Duration": "Documented in medical record",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "LCD DL39909; ⚠️ Dosage per MUSCLE GROUP required (e.g., 'Corrugator: 10 units, Procerus: 5 units') - global '155 units injected' = AUDIT RISK; must document patient continues to meet Chronic Migraine (≥15 days/mo) OR 'Chronic by History' (reduced below threshold but discontinuation would cause regression); NGS Part B FFS = POST-SERVICE review (TPE) - NO PA number required; Medicare Advantage = pre-service PA required",
          "contraBypass": "Yes - documented oral failures with adverse events",
          "goldCardAvail": "No - Federal Medicare",
          "goldCardThresh": null,
          "policyId": "LCD DL39909",
          "sourceDoc": "Massachusetts_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        },
        "CGRP mAbs (IV)": {
          "state": "MA",
          "payerName": "National Government Services (NGS)",
          "payerType": "Medicare MAC",
          "lob": "Part B",
          "drugClass": "CGRP mAbs (IV)",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes (for MA plans)",
          "step1Req": "NGS Part B FFS: medical necessity (Chronic Migraine + oral preventive failures); ⚠️ NO requirement to fail SC CGRPs under NGS Part B - accessible for seniors who cannot self-inject; MA plans often require 2 oral + 1-2 SC CGRP failures before Vyepti",
          "step1Duration": "Documented failure orals; SC CGRP failure NOT required under NGS FFS",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "J3032; NGS FFS = no SC CGRP step (advantage for dexterity issues/cannot self-inject); Medicare Advantage = pre-service PA with SC CGRP step",
          "contraBypass": "Yes - inability to self-inject; dexterity issues",
          "goldCardAvail": "No - Federal Medicare",
          "goldCardThresh": null,
          "policyId": "LCD DL39909",
          "sourceDoc": "Massachusetts_2026_PA_Audit",
          "denialCode": "DENY-QL-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "CO-MCD-HEALTHFIRST": {
        "Gepants (Acute)": {
          "state": "CO",
          "payerName": "Health First Colorado (Medicaid)",
          "payerType": "Medicaid Unified",
          "lob": "Medicaid",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 preferred triptans (Sumatriptan, Rizatriptan, Eletriptan); failure = lack of efficacy/allergy/intolerable side effects/drug-drug interactions",
          "step1Duration": "Documented failure",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "NON-PREFERRED: Ubrelvy, Nurtec ODT, Reyvow; ⚠️ Eletriptan is PREFERRED (higher efficacy than Sumatriptan - strategic advantage)",
          "contraBypass": "Yes - CV Contraindication (vasoconstrictive agents contraindicated due to ischemic heart disease/uncontrolled HTN/significant risk factors like smoking/obesity/diabetes)",
          "goldCardAvail": "N/A - Medicaid FFS exemptions vary",
          "goldCardThresh": null,
          "policyId": "HCPF PDL 01-01-26",
          "sourceDoc": "Colorado_2026_PA_Audit",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "CGRP mAbs (SC)": {
          "state": "CO",
          "payerName": "Health First Colorado (Medicaid)",
          "payerType": "Medicaid Unified",
          "lob": "Medicaid",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 different oral preventive classes (Beta-blockers: Propranolol/Metoprolol, Antidepressants: Amitriptyline/Venlafaxine, Anticonvulsants: Topiramate/Divalproex)",
          "step1Duration": "⚠️ ≥8 WEEKS each at therapeutic dose (strict - '4-week trial' notations = denied for 'inadequate duration')",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "PREFERRED: Ajovy, Emgality; NON-PREFERRED: Aimovig, Vyepti (requires failure of preferred agents or specific medical necessity like latex allergy for Aimovig or IV need for Vyepti)",
          "contraBypass": "Yes - 'Serious or Complex Medical Condition' bypass (Appendix P) for status migrainosus or severe functional impairment risking hospitalization; teratogenic contraindication; respiratory contraindication (asthma) to beta-blockers",
          "goldCardAvail": "N/A - Medicaid",
          "goldCardThresh": null,
          "policyId": "HCPF PDL 01-01-26",
          "sourceDoc": "Colorado_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Neurotoxins": {
          "state": "CO",
          "payerName": "Health First Colorado (Medicaid)",
          "payerType": "Medicaid Unified",
          "lob": "Medical Benefit",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "Documented failure",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Chronic Migraine (ICHD-3): ≥15 HA days/month for >3 months with ≥8 migrainous days; ⚠️ HEADACHE DIARY MANDATORY - 'Patient reports 18 headache days in November' required; 'frequent headaches' = DENIAL",
          "contraBypass": "Yes - oral preventive contraindications",
          "goldCardAvail": "N/A - Medicaid",
          "goldCardThresh": null,
          "policyId": "HCPF Medical Benefit",
          "sourceDoc": "Colorado_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        }
      },
      "CO-COM-CIGNA": {
        "Gepants (Acute)": {
          "state": "CO",
          "payerName": "Cigna Healthcare Colorado",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥1 triptan; Express Scripts PBM has 365-day lookback - if triptan claim in last year, PA may process automatically at POS; if >1 year old, manual PA to 'remind' system",
          "step1Duration": "Documented failure or claims lookback",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "PREFERRED: Sumatriptan, Rizatriptan, Zolmitriptan; NON-PREFERRED: Ubrelvy, Nurtec",
          "contraBypass": "Yes - 'Chest pressure and tightness (triptan sensation) mimicking angina upon triptan administration' = significant intolerance",
          "goldCardAvail": "HB 24-1149 ACTIVE",
          "goldCardThresh": "Statutory compliance",
          "policyId": "Cigna CNF_469",
          "sourceDoc": "Colorado_2026_PA_Audit",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "CGRP mAbs (SC)": {
          "state": "CO",
          "payerName": "Cigna Healthcare Colorado",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "No",
          "step1Req": "⚑ FIRST-LINE CGRP ACCESS — Cigna removed step therapy requirement for CGRP inhibitors as first-line treatment for qualifying patients effective February 1, 2026. Consistent with Cigna's national policy update. Patients no longer required to fail oral preventives before accessing CGRP mAbs on Cigna commercial plans in Colorado.",
          "step1Duration": "⚠️ ≥3 MONTHS each (STRICTEST - most payers 6-8 weeks)",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "PREFERRED: Aimovig, Emgality; NON-PREFERRED: Ajovy; ⚠️ Document SPECIFIC DATES: 'Trial of Topiramate 50mg BID from Jan 1 to April 1, 2024 (3 months) - failed due to lack of efficacy'; MIDAS/HIT-6 scores explicitly referenced in policy - include 'MIDAS Score >11' in notes",
          "contraBypass": "Yes - teratogenic; CV contraindication; 'Severe gastroparesis/nausea rendering oral preventives ineffective due to absorption failure - injectable therapy medically necessary'",
          "goldCardAvail": "HB 24-1149 ACTIVE",
          "goldCardThresh": "Statutory compliance",
          "policyId": "Cigna CNF_333",
          "sourceDoc": "Q1-2026-Policy-Refresh",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": "8.0",
          "episodicNotes": "Cigna: Standard episodic (4-7d) = triptan failure only for acute; High-freq episodic (≥8d) = 1 oral class for CGRP; Chronic (≥15d) = 2 oral classes. MIDAS ≥11 required for all preventives."
        },
        "Neurotoxins": {
          "state": "CO",
          "payerName": "Cigna Healthcare Colorado",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "≥3 months each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Chronic Migraine (>15 days/mo); ⚠️ DUAL THERAPY (Botox+CGRP) HIGHLY RESTRICTED - 'duplication of therapy'; must frame as 'augmentation for partial responder' using AHS 2024 Consensus Statement: 'CGRP mAbs and OnabotulinumtoxinA have distinct pharmacological targets (ligand/receptor vs presynaptic release) - this is mechanistic augmentation not duplication'",
          "contraBypass": "Yes - oral preventive contraindications; 'distinct pharmacological targets' argument for dual therapy",
          "goldCardAvail": "HB 24-1149 ACTIVE",
          "goldCardThresh": "Statutory compliance",
          "policyId": "Cigna Botox Policy",
          "sourceDoc": "Colorado_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        }
      },
      "CO-PARTB-NOVITAS": {
        "Neurotoxins": {
          "state": "CO",
          "payerName": "Novitas Solutions (CO)",
          "payerType": "Medicare MAC",
          "lob": "Part B",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "'Conservative management' failure implied; document ≥2 oral preventive failures for audit defense",
          "step1Duration": "Documented in medical record",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "LCD L38809; ⚠️ Diagnosis must code G43.709 or G43.719 (INTRACTABLE key); frequency 12 weeks STRICT - 10-11 week injections DENIED unless documented 'medical necessity for accelerated dosing' (rarely approved); must state 'Headache frequency >15 days/month, duration >4 hours/day' + list specific muscles injected with dosage per site",
          "contraBypass": "Must achieve >50% reduction in headache days/episodes for continuation",
          "goldCardAvail": "No - Federal Medicare",
          "goldCardThresh": null,
          "policyId": "LCD L38809",
          "sourceDoc": "Q1-2026-Policy-Refresh",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "episodic migraine strictly excluded; must document >15 days/month"
        },
        "CGRP mAbs (IV)": {
          "state": "CO",
          "payerName": "Novitas Solutions (CO)",
          "payerType": "Medicare MAC",
          "lob": "Part B",
          "drugClass": "CGRP mAbs (IV)",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes (for MA plans)",
          "step1Req": "⚠️ Original Medicare FFS = NO step therapy requiring SC CGRP failure before Vyepti (go straight to Vyepti if oral agents failed); Medicare Advantage (UHC/Anthem MA) CAN and DO enforce SC CGRP step",
          "step1Duration": "Oral preventive failures documented",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "J3032; follows FDA labeling + 'conservative management' failure; ⚠️ $2,000 Part D cap = prescribe branded CGRPs (Qulipta) in January to hit cap by Q1-Q2, then $0 cost rest of year - stable year-round treatment now viable for seniors",
          "contraBypass": "Yes - inability to self-inject; cognitive/physical inability",
          "goldCardAvail": "No - Federal Medicare",
          "goldCardThresh": null,
          "policyId": "LCD L38809",
          "sourceDoc": "Colorado_2026_PA_Audit",
          "denialCode": "DENY-QL-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "AZ-PARTB-NORIDIAN": {
        "Neurotoxins": {
          "state": "AZ",
          "payerName": "Noridian Healthcare Solutions (AZ)",
          "payerType": "Medicare MAC",
          "lob": "Part B",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "Same as AZ-MAC-NORIDIAN — updated Botox LCD effective February 22, 2026 with tightened chronic migraine documentation requirements.",
          "step1Duration": "Documented",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "⚠️ WISeR PILOT; LCD L35172/DL39909; G43.709 required; 12wk strict; JW/JZ MANDATORY",
          "contraBypass": "Yes - documented oral failures",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "LCD L35172/DL39909",
          "sourceDoc": "Q1-2026-Policy-Refresh",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "Updated coding guidelines and modifiers effective March 5, 2026.",
          "siteOfCare": "Same as AZ-MAC-NORIDIAN — updated Botox LCD effective February 22, 2026 with tightened chronic migraine documentation requirements."
        }
      },
      "NV-MCD-SPDL": {
        "Gepants (Acute)": {
          "state": "NV",
          "payerName": "Nevada Medicaid (sPDL)",
          "payerType": "Medicaid Unified",
          "lob": "Medicaid",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥1 triptan (harmonization toward 'rule of one'); document 2 to be safe",
          "step1Duration": "Recent or documented",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "PREFERRED: Nurtec ODT; NON-PREFERRED: Ubrelvy (PA + skip Nurtec reason); QL 16/30d; ⚠️ AB 463 = 2 business day response",
          "contraBypass": "Yes - CV contraindication",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "Nevada sPDL",
          "sourceDoc": "Nevada_2026_PA_Audit",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "CGRP mAbs (SC)": {
          "state": "NV",
          "payerName": "Nevada Medicaid (sPDL)",
          "payerType": "Medicaid Unified",
          "lob": "Medicaid",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "Episodic (4-14d): 1 oral class; Chronic (≥15d): 1 oral class",
          "step1Duration": "≥2 months",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "PREFERRED: Aimovig, Emgality; Ajovy requires preferred failure; Medicaid does NOT mandate Botox failure before CGRP (parallel options)",
          "contraBypass": "Yes - teratogenic; cognitive; respiratory",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "Nevada sPDL",
          "sourceDoc": "Q1-2026-Policy-Refresh",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "Updated approved age of Ajovy for episodic migraine."
        },
        "Neurotoxins": {
          "state": "NV",
          "payerName": "Nevada Medicaid (sPDL)",
          "payerType": "Medicaid Unified",
          "lob": "Medical Benefit",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes + MOH ruled out",
          "step1Duration": "Documented",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Chronic only (≥15d); 'frequent headaches' insufficient; ⚠️ 90-day Continuity of Care for plan switches",
          "contraBypass": "Yes - oral contraindications",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "Nevada sPDL",
          "sourceDoc": "Nevada_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        }
      },
      "NV-COM-HPN": {
        "Gepants (Acute)": {
          "state": "NV",
          "payerName": "Health Plan of Nevada (UHC)",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 triptans",
          "step1Duration": "Documented",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Nurtec/Ubrelvy; Smart Edits automation; QL standard",
          "contraBypass": "Yes - CV contraindication",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "HPN Formulary",
          "sourceDoc": "Nevada_2026_PA_Audit",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "CGRP mAbs (SC)": {
          "state": "NV",
          "payerName": "Health Plan of Nevada (UHC)",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral classes",
          "step1Duration": "≥6 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "PREFERRED: Aimovig, Emgality; Ajovy excluded (allergic reaction/failure of preferred required); closed HMO network",
          "contraBypass": "Yes - teratogenic; cognitive; respiratory",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "HPN Formulary",
          "sourceDoc": "Nevada_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "NV-PARTB-NORIDIAN": {
        "Neurotoxins": {
          "state": "NV",
          "payerName": "Noridian Healthcare Solutions (NV)",
          "payerType": "Medicare MAC",
          "lob": "Part B",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "Requires inadequate response to at least one agent in two classes of oral medications AND documentation of prior CGRP therapy. Also requires objective documentation of functional disability (e.g., MIDAS, HIT-6).",
          "step1Duration": "Documented",
          "step2Req": "Requires inadequate response to at least one agent in two classes of oral medications AND documentation of prior CGRP therapy. Also requires objective documentation of functional disability (e.g., MIDAS, HIT-6).",
          "step2Duration": null,
          "quantityLimit": "LCD L35170; Chronic Migraine only; Episodic = off-label non-covered; 12wk spacing strict",
          "contraBypass": "Yes - documented oral failures",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "LCD L35170",
          "sourceDoc": "Q1-2026-Policy-Refresh",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "Requires inadequate response to at least one agent in two classes of oral medications AND documentation of prior CGRP therapy. Also requires objective documentation of functional disability (e.g., MIDAS, HIT-6)."
        }
      },
      "NM-COM-PRESBY": {
        "Gepants (Acute)": {
          "state": "NM",
          "payerName": "Presbyterian Health Plan",
          "payerType": "Commercial/Medicaid",
          "lob": "Commercial/Medicaid",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 triptans (failure/lack of efficacy/intolerance documented)",
          "step1Duration": "Documented",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Tier 3 Non-Preferred",
          "contraBypass": "Yes - CV contraindication",
          "goldCardAvail": "⚠️ NMAC 13.10.31.12",
          "goldCardThresh": "90% (carrier selects)",
          "policyId": "Presbyterian Policy",
          "sourceDoc": "New_Mexico_2026_PA_Audit",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "NM-COM-UHC": {
        "CGRP mAbs (SC)": {
          "state": "NM",
          "payerName": "UnitedHealthcare New Mexico",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 agents",
          "step1Duration": "≥8 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Vyepti Tier 4 requires failure of 2 preferred SC CGRPs; ⚠️ UHC acknowledges NMAC supersedes national policy",
          "contraBypass": "Yes - teratogenic; cognitive; respiratory",
          "goldCardAvail": "✓ NMAC acknowledged",
          "goldCardThresh": "90%",
          "policyId": "UHC CGRP",
          "sourceDoc": "New_Mexico_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Gepants (Preventive)": {
          "state": "NM",
          "payerName": "UHC New Mexico",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Preventive)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 agents for 8 weeks (UHC standard)",
          "step1Duration": "≥8 weeks",
          "step2Req": "Inferred: May require self-injectable CGRP step",
          "step2Duration": null,
          "quantityLimit": "30 tabs/30 days",
          "contraBypass": "Yes - standard CGRP bypasses",
          "goldCardAvail": "No",
          "goldCardThresh": null,
          "policyId": null,
          "sourceDoc": "New_Mexico_2026_PA_Audit.docx",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "FALLBACK from CGRP mAb Step Therapy"
        }
      },
      "NM-PARTB-NOVITAS": {
        "Neurotoxins": {
          "state": "NM",
          "payerName": "Novitas Solutions (NM)",
          "payerType": "Medicare MAC",
          "lob": "Part B",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "Conventional therapy failure",
          "step1Duration": "Documented",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "LCD L38809; ⚠️ ICD-10 G43.7 series REQUIRED (G43.9 = auto-denial); 12wk; '15+ days' + '4+ hours' documentation",
          "contraBypass": "Yes - documented oral failures",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "LCD L38809",
          "sourceDoc": "New_Mexico_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        }
      },
      "UT-COM-SELECTHEALTH": {
        "Gepants (Acute)": {
          "state": "UT",
          "payerName": "SelectHealth",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 triptans",
          "step1Duration": "Documented",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Tier 4/5 RxCore; QL Ubrelvy 16/30d; Nurtec acute 8/30d (>8 = preventive review)",
          "contraBypass": "Yes - CV contraindication",
          "goldCardAvail": "⚠️ SB 274 (Mar 2026)",
          "goldCardThresh": "Transparency reporting",
          "policyId": "SelectHealth RxCore",
          "sourceDoc": "Utah_2026_PA_Audit",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "CGRP mAbs (SC)": {
          "state": "UT",
          "payerName": "SelectHealth",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "≥2 months each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Tier 4/5; PREFERRED: Ajovy, Emgality; NON-PREFERRED: Aimovig (requires preferred failure); ⚠️ New Preauth Tool may friction external providers",
          "contraBypass": "Yes - teratogenic; cognitive; respiratory",
          "goldCardAvail": "⚠️ SB 274",
          "goldCardThresh": "Transparency",
          "policyId": "SelectHealth RxCore",
          "sourceDoc": "Utah_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "UT-COM-UUHP": {
        "CGRP mAbs (SC)": {
          "state": "UT",
          "payerName": "Healthy U (UUHP)",
          "payerType": "Medicaid",
          "lob": "Medicaid",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral classes",
          "step1Duration": "Documented",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "pharm-hu-016; PREFERRED: Ajovy, Emgality; NON-PREFERRED: Aimovig (requires both preferred failure); ⚠️ Migraine NOT on 2026 Hybrid Unified PDL",
          "contraBypass": "Yes - teratogenic; cognitive; respiratory",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "pharm-hu-016",
          "sourceDoc": "Utah_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Gepants (Preventive)": {
          "state": "UT",
          "payerName": "Healthy U (UUHP)",
          "payerType": "Medicaid",
          "lob": "Medicaid",
          "drugClass": "Gepants (Preventive)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "⚠️ Step 3: Must fail Ajovy AND Emgality AND Aimovig OR documented injection disability/phobia",
          "step1Duration": "Documented",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Effectively 'last-line' option in UT Medicaid",
          "contraBypass": "Yes - injection phobia/disability",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "pharm-hu-016",
          "sourceDoc": "Utah_2026_PA_Audit",
          "denialCode": "DENY-QL-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "CGRP mAbs (Cluster)": {
          "state": "UT",
          "payerName": "Healthy U (UUHP)",
          "payerType": "Medicaid",
          "lob": "Medicaid",
          "drugClass": "CGRP mAbs (Cluster)",
          "medCategory": "Cluster Headache",
          "stepTherapyRequired": "Yes",
          "step1Req": "⚠️ Verapamil titrated to maximum tolerated dose required first",
          "step1Duration": "Documented titration",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Emgality 100mg for episodic cluster; Verapamil requirement = common PA failure point (under-dosing)",
          "contraBypass": "Yes - Verapamil contraindication",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "pharm-hu-016",
          "sourceDoc": "Utah_2026_PA_Audit",
          "denialCode": "DENY-QL-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "UT-PARTB-NORIDIAN": {
        "Neurotoxins": {
          "state": "UT",
          "payerName": "Noridian Healthcare Solutions (UT)",
          "payerType": "Medicare MAC",
          "lob": "Part B",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "Same as UT-MAC-NORIDIAN — updated Botox LCD effective February 22, 2026",
          "step1Duration": "Same as UT-MAC-NORIDIAN — updated Botox LCD effective February 22, 2026",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "LCD L35170; ⚠️ PA Demonstration for CPT 64612/64615 (HOPD must secure PA); 12wk; '15/4' rule (≥15d + ≥4hr)",
          "contraBypass": "Yes - documented oral failures",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "LCD L35170",
          "sourceDoc": "Q1-2026-Policy-Refresh",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        }
      },
      "OR-COM-REGENCE": {
        "Gepants (Acute)": {
          "state": "OR",
          "payerName": "Regence BCBS Oregon",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 triptans",
          "step1Duration": "Documented",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Policy dru540 step; QL 16/30d Ubrelvy; QL Exception requires frequency documentation",
          "contraBypass": "Yes - CV contraindication",
          "goldCardAvail": "⚠️ HB 3134 Transparency",
          "goldCardThresh": null,
          "policyId": "Regence dru540",
          "sourceDoc": "Oregon_2026_PA_Audit",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "CGRP mAbs (SC)": {
          "state": "OR",
          "payerName": "Regence BCBS Oregon",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 classes (Beta-blockers/TCAs/Anticonvulsants)",
          "step1Duration": "≥2 months each + compliance documented",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Policy dru540; ⚠️ 'Failure' insufficient - chart notes must show COMPLIANCE during trial; Vyepti requires SC CGRP trial first",
          "contraBypass": "Yes - teratogenic; cognitive; respiratory",
          "goldCardAvail": "⚠️ HB 3134",
          "goldCardThresh": null,
          "policyId": "Regence dru540",
          "sourceDoc": "Oregon_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Gepants (Preventive)": {
          "state": "OR",
          "payerName": "OEBB/Regence",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Preventive)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "Standard CGRP criteria",
          "step1Duration": "≥8 weeks",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "30 tabs/30 days",
          "contraBypass": "Yes - standard",
          "goldCardAvail": "No",
          "goldCardThresh": null,
          "policyId": null,
          "sourceDoc": "Oregon_2026_PA_Audit.docx",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "Non-Preferred (N) status"
        }
      },
      "OR-COM-KAISER": {
        "Neurotoxins": {
          "state": "OR",
          "payerName": "Kaiser Permanente Northwest",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "⚠️ ≥3 drug class failures (stricter than 2-class standard)",
          "step1Duration": "Documented",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Tier 2 internal; highest barriers; closed formulary",
          "contraBypass": "Yes - oral contraindications",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "Kaiser Internal",
          "sourceDoc": "Oregon_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        },
        "CGRP mAbs (SC)": {
          "state": "OR",
          "payerName": "Kaiser Permanente Northwest",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "Multiple oral failures + internal referral",
          "step1Duration": "Documented",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "⚠️ HIGHEST BARRIERS; PCPs CANNOT prescribe CGRPs - must refer to Neurology; internal protocols; ORS 743B.225 90-day Continuity shield",
          "contraBypass": "Yes - teratogenic; cognitive; respiratory",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "Kaiser Internal",
          "sourceDoc": "Oregon_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "OR-PARTB-NORIDIAN": {
        "Neurotoxins": {
          "state": "OR",
          "payerName": "Noridian Healthcare Solutions (OR)",
          "payerType": "Medicare MAC",
          "lob": "Part B",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "Inadequate response to at least one agent in two classes of completed medications",
          "step1Duration": "Documented",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "JF; LCD L35170; 12wk; HOPD PA demonstration may apply",
          "contraBypass": "Yes - documented oral failures",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "LCD L35170",
          "sourceDoc": "Q1-2026-Policy-Refresh",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "Requires documentation of calcitonin gene-related peptide (CGRP) therapy, if used concurrently or previously"
        }
      },
      "MD-COM-KAISER": {
        "CGRP mAbs (SC)": {
          "state": "MD",
          "payerName": "Kaiser Permanente Mid-Atlantic",
          "payerType": "Integrated HMO",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "⚠️ ≥3 classes (Beta-blocker/TCA/Topiramate or Valproate)",
          "step1Duration": "Documented",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "RESTRICTED; requires Kaiser Neurologist referral; PCPs cannot prescribe",
          "contraBypass": "Yes - teratogenic; cognitive; respiratory",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "Kaiser Internal",
          "sourceDoc": "Maryland_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Neurotoxins": {
          "state": "MD",
          "payerName": "Kaiser Permanente Mid-Atlantic",
          "payerType": "Integrated HMO",
          "lob": "Commercial",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥3 different drug classes",
          "step1Duration": "≥2 months each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "⚠️ STOPPING RULE: If <50% reduction after 2 cycles (6 months) = coverage discontinued (stricter than 30% elsewhere)",
          "contraBypass": "Yes - oral contraindications",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "Kaiser Internal",
          "sourceDoc": "Maryland_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        }
      },
      "MD-MCD-PRIORITY": {
        "CGRP mAbs (SC)": {
          "state": "MD",
          "payerName": "Maryland Medicaid (Priority Partners)",
          "payerType": "Medicaid MCO",
          "lob": "Medicaid",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventives with specific dates documented",
          "step1Duration": "≥8 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Mirrors state PDL; Ajovy/Emgality listed; Aimovig non-preferred",
          "contraBypass": "Yes - teratogenic; cognitive; respiratory",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "MD PDL",
          "sourceDoc": "Maryland_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Neurotoxins": {
          "state": "MD",
          "payerName": "Maryland Medicaid",
          "payerType": "Medicaid",
          "lob": "Medicaid",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral classes (lower than Kaiser's 3)",
          "step1Duration": "Documented",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Chronic Migraine only",
          "contraBypass": "Yes - oral contraindications",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "MD PDL",
          "sourceDoc": "Maryland_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        }
      },
      "MD-MCD-MPC": {
        "CGRP mAbs (SC)": {
          "state": "MD",
          "payerName": "Maryland Physicians Care",
          "payerType": "Medicaid MCO",
          "lob": "Medicaid",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "⚠️ Universal Opioid/Pain/Migraine PA Form required; ≥2 oral preventives",
          "step1Duration": "≥8 weeks EACH",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Ajovy/Emgality on PDL; Aimovig non-preferred",
          "contraBypass": "Yes - teratogenic; cognitive; respiratory",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "MD PDL",
          "sourceDoc": "Maryland_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "MD-PARTB-NOVITAS": {
        "Neurotoxins": {
          "state": "MD",
          "payerName": "Novitas Solutions (MD)",
          "payerType": "Medicare MAC",
          "lob": "Part B",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "Conventional therapy failure documented",
          "step1Duration": "Documented",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "LCD L38809; CPT 64615 (not 64612); 15+ days + 4+ hours; 12wk strict; ⚠️ MA plans may layer Part D SC CGRP step before Part B Vyepti",
          "contraBypass": "Yes - documented oral failures",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "LCD L38809",
          "sourceDoc": "Q1-2026-Policy-Refresh",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series.",
          "siteOfCare": "Mandatory Prior Authorization required for administration in ASC and HOPD settings (WISeR model demonstration)"
        }
      },
      "DE-COM-HIGHMARK": {
        "Gepants (Acute)": {
          "state": "DE",
          "payerName": "Highmark BCBS Delaware",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 preferred triptans (Sumatriptan/Rizatriptan/Eletriptan)",
          "step1Duration": "Documented",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "QL 16/30d; CV bypass = document comorbidity ICD-10; gastroparesis = Nurtec ODT absorption argument",
          "contraBypass": "Yes - CV contraindication; gastroparesis",
          "goldCardAvail": "✓ Voluntary 90%",
          "goldCardThresh": "90% (30+ procedures/yr)",
          "policyId": "Formulary J-1207",
          "sourceDoc": "Delaware_2026_PA_Audit",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "CGRP mAbs (SC)": {
          "state": "DE",
          "payerName": "Highmark BCBS Delaware",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥1 agent from ≥2 different classes (Beta-blocker/Antidepressant/Anti-epileptic/Angiotensin)",
          "step1Duration": "≥8 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Policy I-200-005; ⚠️ Vyepti I-222-007 requires justification why SC CGRP cannot be used",
          "contraBypass": "Yes - teratogenic (Topiramate/Valproate WOCBP); cognitive; respiratory; diabetes/hypotension (beta-blockers)",
          "goldCardAvail": "✓ Voluntary 90%",
          "goldCardThresh": "90%",
          "policyId": "Policy I-200-005",
          "sourceDoc": "Delaware_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Neurotoxins": {
          "state": "DE",
          "payerName": "Highmark BCBS Delaware",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 prophylactic classes",
          "step1Duration": "≥6 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Policy I-11-042; Chronic only (15/8); ⚠️ Dual Therapy flagged as 'duplicate' - use AHS 2024 synergistic mechanism defense",
          "contraBypass": "Yes - oral contraindications",
          "goldCardAvail": "✓ Voluntary 90%",
          "goldCardThresh": "90%",
          "policyId": "Policy I-11-042",
          "sourceDoc": "Delaware_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        },
        "CGRP mAbs (IV)": {
          "state": "DE",
          "payerName": "Highmark BCBS Delaware",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (IV)",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "Must justify why SC CGRP cannot be used",
          "step1Duration": "Documented",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Policy I-222-007; needle phobia/inability to self-inject/SC failure = valid bypass",
          "contraBypass": "Concurrent use with a second chemically distinct CGRP inhibitor is allowed provided the prescriber attests benefits outweigh risks.",
          "goldCardAvail": "✓ Voluntary 90%",
          "goldCardThresh": "90%",
          "policyId": "Policy I-222-007",
          "sourceDoc": "Q1-2026-Policy-Refresh",
          "denialCode": "DENY-QL-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "DE-MCD-DEFIRST": {
        "CGRP mAbs (SC)": {
          "state": "DE",
          "payerName": "Delaware First Health (Centene)",
          "payerType": "Medicaid MCO",
          "lob": "Medicaid",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 PDL agents",
          "step1Duration": "Documented",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "⚠️ D-SNP Exclusive Alignment Jan 2026 = forced switches; 90-day transition fill; cite 18 Del C § 3381(a)(5) Stability Exception",
          "contraBypass": "Yes - stability on current regimen",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "DMAP PDL",
          "sourceDoc": "Delaware_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "DE-PARTB-NOVITAS": {
        "Neurotoxins": {
          "state": "DE",
          "payerName": "Novitas Solutions (DE)",
          "payerType": "Medicare MAC",
          "lob": "Part B",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "Conventional therapy failure",
          "step1Duration": "Documented",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "LCD L38809; JL jurisdiction; same as MD",
          "contraBypass": "Yes - documented oral failures",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "LCD L38809",
          "sourceDoc": "Delaware_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        }
      },
      "WV-COM-HIGHMARK": {
        "CGRP mAbs (SC)": {
          "state": "WV",
          "payerName": "Highmark BCBS West Virginia",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "No",
          "step1Req": "⚠️ FIRST-LINE VICTORY: NO oral failure required (effective Oct 2025)",
          "step1Duration": null,
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Aimovig/Ajovy/Emgality = preferred; reauth = 'clinical benefit' (reduction in migraine days - not strict 50%)",
          "contraBypass": "N/A - First-Line",
          "goldCardAvail": "⚠️ SB 833 excludes drugs",
          "goldCardThresh": null,
          "policyId": "Highmark Policy",
          "sourceDoc": "West_Virginia_2026_PA_Audit",
          "denialCode": "DENY-FIRST-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Gepants (Acute)": {
          "state": "WV",
          "payerName": "Highmark BCBS West Virginia",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 generic triptans + 1 additional acute agent (different triptan/NSAID/DHE)",
          "step1Duration": "Documented",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "QL Ubrelvy 16/30d; Nurtec acute 8/30d; CV bypass with ICD-10 code (I10 HTN)",
          "contraBypass": "Permitted with prescriber attestation that benefits outweigh risks",
          "goldCardAvail": "⚠️ SB 833 excludes drugs",
          "goldCardThresh": null,
          "policyId": "Highmark Policy",
          "sourceDoc": "Q1-2026-Policy-Refresh",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Neurotoxins": {
          "state": "WV",
          "payerName": "Highmark BCBS West Virginia",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "Oral preventive failure typically required (medical policy lags pharmacy)",
          "step1Duration": "Documented",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "⚠️ DUAL THERAPY ALLOWANCE: Policy J-1207 permits Botox + CGRP if partial response (≥2 day reduction)",
          "contraBypass": "Yes - oral contraindications",
          "goldCardAvail": "⚠️ SB 833 excludes drugs",
          "goldCardThresh": null,
          "policyId": "Highmark J-1207",
          "sourceDoc": "West_Virginia_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        }
      },
      "WV-COM-THP": {
        "Gepants (Acute)": {
          "state": "WV",
          "payerName": "The Health Plan (WV)",
          "payerType": "Commercial/PEIA",
          "lob": "Commercial",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 triptans",
          "step1Duration": "⚠️ 720-day claims lookback",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Tier 3 Non-Preferred; Express Scripts; ⚠️ New members = history invisible = submit records",
          "contraBypass": "Yes - CV contraindication",
          "goldCardAvail": "⚠️ SB 833 excludes drugs",
          "goldCardThresh": null,
          "policyId": "THP Formulary",
          "sourceDoc": "West_Virginia_2026_PA_Audit",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "CGRP mAbs (SC)": {
          "state": "WV",
          "payerName": "The Health Plan (WV)",
          "payerType": "Commercial/PEIA",
          "lob": "PEIA",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "Oral preventive failure (PEIA = fail-first enforced, not Highmark First-Line)",
          "step1Duration": "Documented",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "PEIA: Aimovig/Emgality preferred; Ajovy requires preferred failure",
          "contraBypass": "Yes - teratogenic; cognitive; respiratory",
          "goldCardAvail": "⚠️ SB 833 excludes drugs",
          "goldCardThresh": null,
          "policyId": "THP/PEIA Formulary",
          "sourceDoc": "West_Virginia_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "WV-COM-CARESOURCE": {
        "Gepants (Acute)": {
          "state": "WV",
          "payerName": "CareSource West Virginia",
          "payerType": "Exchange/Medicaid",
          "lob": "Exchange",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 triptans + step therapy",
          "step1Duration": "Documented",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "⚠️ Nurtec Tier 4 SPECIALTY (coinsurance not copay); IRA $2,100 cap critical",
          "contraBypass": "Yes - CV contraindication",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "CareSource Formulary",
          "sourceDoc": "West_Virginia_2026_PA_Audit",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "WV-PARTB-PALMETTO": {
        "Neurotoxins": {
          "state": "WV",
          "payerName": "Palmetto GBA (WV)",
          "payerType": "Medicare MAC",
          "lob": "Part B",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "Conservative therapy failure + objective scales",
          "step1Duration": "Documented",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Every 12 weeks max",
          "contraBypass": "Yes - documented oral failures with objective disability scores",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "LCD DL39909",
          "sourceDoc": "Q1-2026-Policy-Refresh",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        }
      },
      "RI-COM-BCBSRI": {
        "Gepants (Acute)": {
          "state": "RI",
          "payerName": "Blue Cross Blue Shield RI",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 triptans",
          "step1Duration": "Documented",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Prime Therapeutics; baseline step-therapy for state",
          "contraBypass": "Yes - CV contraindication",
          "goldCardAvail": "⚠️ HB 5120 excludes drugs + specialists",
          "goldCardThresh": null,
          "policyId": "BCBSRI Formulary",
          "sourceDoc": "Rhode_Island_2026_PA_Audit",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "CGRP mAbs (SC)": {
          "state": "RI",
          "payerName": "Blue Cross Blue Shield RI",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral classes",
          "step1Duration": "Documented",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Step therapy baseline",
          "contraBypass": "Yes - teratogenic; cognitive; respiratory",
          "goldCardAvail": "⚠️ HB 5120 excludes drugs",
          "goldCardThresh": null,
          "policyId": "BCBSRI Formulary",
          "sourceDoc": "Rhode_Island_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Gepants (Preventive)": {
          "state": "RI",
          "payerName": "BCBS RI",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Preventive)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "Fail 2 oral preventive classes AND injectable CGRP mAbs",
          "step1Duration": "≥8 weeks",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "30 tabs/30 days",
          "contraBypass": "Yes - needle phobia",
          "goldCardAvail": "No",
          "goldCardThresh": null,
          "policyId": null,
          "sourceDoc": "Rhode_Island_2026_PA_Audit.docx",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "Restricted - requires injectable CGRP failure"
        }
      },
      "RI-MCD-NHPRI": {
        "Gepants (Acute)": {
          "state": "RI",
          "payerName": "Neighborhood Health Plan RI",
          "payerType": "Medicaid/Exchange",
          "lob": "Medicaid",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 triptans",
          "step1Duration": "Documented",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "⚠️ UBRELVY PREFERRED over Nurtec (friction point for prescribers)",
          "contraBypass": "Yes - CV contraindication",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "NHPRI Formulary",
          "sourceDoc": "Rhode_Island_2026_PA_Audit",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "RI-MA-UHC": {
        "CGRP mAbs (IV)": {
          "state": "RI",
          "payerName": "UnitedHealthcare Rhode Island",
          "payerType": "Medicare Advantage",
          "lob": "MA",
          "drugClass": "CGRP mAbs (IV)",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "⚠️ Part B Step Therapy: Must fail Part D SC CGRPs (Aimovig/Ajovy/Emgality) before Part B Vyepti",
          "step1Duration": "Documented failures",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Needle phobia/inability to self-inject/cognitive impairment = bypass",
          "contraBypass": "Yes - needle phobia; dexterity; cognitive",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "UHC MA Policy",
          "sourceDoc": "Rhode_Island_2026_PA_Audit",
          "denialCode": "DENY-QL-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "RI-PARTB-NGS": {
        "Neurotoxins": {
          "state": "RI",
          "payerName": "National Government Services (RI)",
          "payerType": "Medicare MAC",
          "lob": "Part B",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "Conservative treatment failure",
          "step1Duration": "Documented",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Maximum recommended dose strictly enforced per FDA label; any excess requires direct appeal with peer-reviewed literature and notes",
          "contraBypass": "Yes - documented oral failures",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "LCD L33646/DL39909",
          "sourceDoc": "Q1-2026-Policy-Refresh",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        }
      },
      "CT-MCD-HUSKY": {
        "Gepants (Acute)": {
          "state": "CT",
          "payerName": "Connecticut Medicaid (HUSKY)",
          "payerType": "Medicaid FFS",
          "lob": "Medicaid",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 preferred triptans",
          "step1Duration": "Documented with dates/dosages/reasons",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "⚠️ 2026 Clinical Criteria Pilot - dedicated 'Antimigraine Other CGRP Antagonists' PA form required; PREFERRED: Nurtec ODT, Ubrelvy; NON-PREFERRED: Zavzpret, Reyvow",
          "contraBypass": "Yes - CV contraindication; gastroparesis",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "CT PDL/Pilot",
          "sourceDoc": "Connecticut_2026_PA_Audit",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "CGRP mAbs (SC)": {
          "state": "CT",
          "payerName": "Connecticut Medicaid (HUSKY)",
          "payerType": "Medicaid FFS",
          "lob": "Medicaid",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥1 oral preventive class",
          "step1Duration": "≥8 weeks",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "PREFERRED: Ajovy, Emgality 120mg, Nurtec ODT (prev), Qulipta; NON-PREFERRED: Aimovig, Vyepti; ⚠️ 90-day grace to Mar 31 2026 for established patients on non-preferred",
          "contraBypass": "Yes - teratogenic; cognitive; respiratory",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "CT PDL/Pilot",
          "sourceDoc": "Connecticut_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "CT-COM-ANTHEM": {
        "CGRP mAbs (SC)": {
          "state": "CT",
          "payerName": "Anthem BCBS Connecticut",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral classes",
          "step1Duration": "Documented",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "PREFERRED: Ajovy, Emgality, Qulipta; Aimovig often NON-PREFERRED; PA 25-94 Step Therapy Reform = Continuity of Care protection",
          "contraBypass": "Yes - teratogenic; cognitive; respiratory; PA 25-94 stability protection",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "Anthem CT Formulary",
          "sourceDoc": "Connecticut_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": "8.0",
          "episodicNotes": "Anthem: Episodic (<8d) = 1 oral class; Episodic (≥8d) = same as chronic (1 oral class). More lenient than most payers for episodic."
        }
      },
      "CT-COM-CONNECTICARE": {
        "CGRP mAbs (SC)": {
          "state": "CT",
          "payerName": "ConnectiCare (Molina)",
          "payerType": "Exchange/MA",
          "lob": "Exchange",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "ConnectiCare adopted Molina Healthcare's Clinical Policy, Pharmacy Policy Criteria, Marketplace Formulary, and Medicare Formulary for Marketplace and Medicare members effective January 1, 2026. Members with \"K\" ID numbers continue under legacy ConnectiCare policies through 2026. All other ConnectiCare Marketplace and Medicare members are now subject to Molina's PA criteria for CGRP medications.",
          "step1Duration": "Documented",
          "step2Req": "ConnectiCare adopted Molina Healthcare's Clinical Policy, Pharmacy Policy Criteria, Marketplace Formulary, and Medicare Formulary for Marketplace and Medicare members effective January 1, 2026. Members with \"K\" ID numbers continue under legacy ConnectiCare policies through 2026. All other ConnectiCare Marketplace and Medicare members are now subject to Molina's PA criteria for CGRP medications.",
          "step2Duration": null,
          "quantityLimit": "⚠️ FULL Molina integration - verify existing PAs; PA 25-94 Continuity of Care critical during transition",
          "contraBypass": "Yes - stability on current regimen (PA 25-94)",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "Molina/ConnectiCare",
          "sourceDoc": "Q1-2026-Policy-Refresh",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "CT-COM-CIGNA": {
        "Gepants (Acute)": {
          "state": "CT",
          "payerName": "Cigna Healthcare Connecticut",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 triptans",
          "step1Duration": "Documented",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Express Scripts; highly restrictive; strict step therapy",
          "contraBypass": "Yes - CV contraindication",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "Cigna Formulary",
          "sourceDoc": "Connecticut_2026_PA_Audit",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "CT-COM-AETNA": {
        "Gepants (Acute)": {
          "state": "CT",
          "payerName": "Aetna Connecticut",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "Precise triptan failure counts via 'step edits'",
          "step1Duration": "Documented",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "CVS Caremark integration; specific failure counts required",
          "contraBypass": "Yes - CV contraindication",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "Aetna Formulary",
          "sourceDoc": "Connecticut_2026_PA_Audit",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "CT-PARTB-NGS": {
        "Neurotoxins": {
          "state": "CT",
          "payerName": "National Government Services (CT)",
          "payerType": "Medicare MAC",
          "lob": "Part B",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "Conservative therapy failure",
          "step1Duration": "cosmeticExclusion=Strictly enforced (claim denied if any cosmetic intent exists, Z41.1 required for ABN); step1Duration=12-week minimum strictly enforced",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "JK; LCD L33646/DL39909; punitive if documentation lacking; same as RI",
          "contraBypass": "Yes - documented oral failures",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "LCD L33646/DL39909",
          "sourceDoc": "Q1-2026-Policy-Refresh",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        }
      },
      "MI-COM-BCBSM": {
        "Gepants (Acute)": {
          "state": "MI",
          "payerName": "Blue Cross Blue Shield Michigan",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 generic triptans (Sumatriptan/Rizatriptan/Eletriptan)",
          "step1Duration": "≥1 month or inadequate response",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "QL 16/30d typical; ⚠️ MOH review if exceeding QL; Zavzpret = Non-Formulary (requires oral gepant failure + severe nausea/gastroparesis)",
          "contraBypass": "Yes - CV contraindication",
          "goldCardAvail": "✓ MCL 500.2212e",
          "goldCardThresh": "90% (fully insured only)",
          "policyId": "Custom Select Drug List",
          "sourceDoc": "Michigan_2026_PA_Audit",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "CGRP mAbs (SC)": {
          "state": "MI",
          "payerName": "Blue Cross Blue Shield Michigan",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes (Beta-blocker/TCA/Anticonvulsant)",
          "step1Duration": "≥2 months each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "PREFERRED: Aimovig, Emgality; ⚠️ Renewal requires ≥50% reduction in MMDs (quantified); 'patient doing better' insufficient; MIDAS/HIT-6 required",
          "contraBypass": "Yes - teratogenic; cognitive; respiratory; hypotension",
          "goldCardAvail": "✓ MCL 500.2212e",
          "goldCardThresh": "90%",
          "policyId": "BCBSM Policy",
          "sourceDoc": "Michigan_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Neurotoxins": {
          "state": "MI",
          "payerName": "Blue Cross Blue Shield Michigan",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "≥6 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Policy 2027125; Chronic (15/8 ICHD-3); ⚠️ Dual Therapy requires Letter of Medical Necessity citing AHS 2021; often restricted",
          "contraBypass": "Yes - oral contraindications",
          "goldCardAvail": "✓ MCL 500.2212e",
          "goldCardThresh": "90% (CPT 64615)",
          "policyId": "Policy 2027125",
          "sourceDoc": "Michigan_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        }
      },
      "MI-MCD-MERIDIAN": {
        "Gepants (Acute)": {
          "state": "MI",
          "payerName": "Michigan Medicaid (Single PDL)",
          "payerType": "Medicaid",
          "lob": "Medicaid",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 preferred triptans",
          "step1Duration": "Documented",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "QL 16/30d; uniform across MCOs (Meridian/Molina/Blue Cross Complete)",
          "contraBypass": "Yes - CV contraindication",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "MI Single PDL",
          "sourceDoc": "Michigan_2026_PA_Audit",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "CGRP mAbs (SC)": {
          "state": "MI",
          "payerName": "Michigan Medicaid (Single PDL)",
          "payerType": "Medicaid",
          "lob": "Medicaid",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥1-2 oral preventive classes",
          "step1Duration": "≥8-12 weeks",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "PREFERRED: Aimovig, Emgality; Ajovy/Vyepti = Non-Preferred (require preferred failure); Single PDL = uniform pharmacy criteria",
          "contraBypass": "Yes - teratogenic; cognitive; respiratory",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "MI Single PDL",
          "sourceDoc": "Michigan_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "MI-PARTB-WPS": {
        "Neurotoxins": {
          "state": "MI",
          "payerName": "WPS GHA (MI)",
          "payerType": "Medicare MAC",
          "lob": "Part B",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥3 drug classes documented failure",
          "step1Duration": "≥2 months each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "⚠️ LCD L39909 (NEW Feb 15 2026); replaces L34635; 12-week STRICT (10-11 weeks = auto-denial); reduction ≥7 days/month OR functional improvement (MIDAS/HIT-6); maintenance without documented benefit = audit target",
          "contraBypass": "Yes - documented oral failures with scores",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "LCD L39909",
          "sourceDoc": "Michigan_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        }
      },
      "IN-MCD-IHCP": {
        "Gepants (Acute)": {
          "state": "IN",
          "payerName": "Indiana Medicaid (SUPDL)",
          "payerType": "Medicaid FFS",
          "lob": "Medicaid",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 preferred triptans (Sumatriptan/Rizatriptan)",
          "step1Duration": "Documented",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Tier 2 Non-Preferred; ⚠️ Nurtec QL acute = 8 tabs/30d; 16 tabs = preventive PA required",
          "contraBypass": "Yes - CV contraindication",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "SUPDL",
          "sourceDoc": "Indiana_2026_PA_Audit",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "CGRP mAbs (SC)": {
          "state": "IN",
          "payerName": "Indiana Medicaid (SUPDL)",
          "payerType": "Medicaid FFS",
          "lob": "Medicaid",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "Indiana Medicaid antimigraine PA criteria updated per IHCP Bulletin BT202618, approved by DUR Board January 16, 2026. Applies statewide to all MCOs via the SUPDL (State Uniform Preferred Drug List). Effective April 1, 2026. Specific criteria changes include updated PA requirements for CGRP inhibitors.",
          "step1Duration": "Indiana Medicaid antimigraine PA criteria updated per IHCP Bulletin BT202618, approved by DUR Board January 16, 2026. Applies statewide to all MCOs via the SUPDL (State Uniform Preferred Drug List). Effective April 1, 2026. Specific criteria changes include updated PA requirements for CGRP inhibitors.",
          "step2Req": "Indiana Medicaid antimigraine PA criteria updated per IHCP Bulletin BT202618, approved by DUR Board January 16, 2026. Applies statewide to all MCOs via the SUPDL (State Uniform Preferred Drug List). Effective April 1, 2026. Specific criteria changes include updated PA requirements for CGRP inhibitors.",
          "step2Duration": null,
          "quantityLimit": "PREFERRED: Emgality, Aimovig; Ajovy = requires preferred failure; ⚠️ MDwise exit = 90-day continuity then new PA required under new MCE",
          "contraBypass": "Yes - teratogenic; cognitive; respiratory",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "SUPDL",
          "sourceDoc": "Q1-2026-Policy-Refresh",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "IN-COM-ANTHEM": {
        "CGRP mAbs (SC)": {
          "state": "IN",
          "payerName": "Anthem Indiana",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥1 generic oral preventive",
          "step1Duration": "≥2 months",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "PREFERRED: Emgality (Tier 2), Aimovig (Tier 2); NON-PREFERRED: Ajovy, Vyepti (Tier 3)",
          "contraBypass": "Yes - teratogenic; cognitive; respiratory",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "Anthem Commercial Formulary",
          "sourceDoc": "Indiana_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": "8.0",
          "episodicNotes": "Anthem: Episodic (<8d) = 1 oral class; Episodic (≥8d) = same as chronic (1 oral class). More lenient than most payers for episodic."
        },
        "Gepants (Preventive)": {
          "state": "IN",
          "payerName": "Anthem BCBS",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Preventive)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥1 oral preventive class (beta-blocker/TCA/anticonvulsant)",
          "step1Duration": "≥8 weeks",
          "step2Req": "Fail preferred CGRP mAb (Aimovig OR Emgality)",
          "step2Duration": null,
          "quantityLimit": "30 tabs/30 days",
          "contraBypass": "Yes - needle phobia; injection site reactions",
          "goldCardAvail": "No",
          "goldCardThresh": null,
          "policyId": "ING-CC-0032",
          "sourceDoc": "Indiana_2026_PA_Audit.md",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "Third-line therapy positioning"
        },
        "Neurotoxins": {
          "state": "IN",
          "payerName": "Anthem Indiana",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "Documented",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Policy ING-CC-0032; Chronic only (15/8); ⚠️ 'Synergy Barrier' - dual therapy requires documented synergistic benefit distinct from monotherapy failure",
          "contraBypass": "Concurrent use with CGRP allowed ONLY IF patient shows documented reduction in migraine days with CGRP but continues to experience significant/severe migraine days requiring additional therapy.",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "ING-CC-0032",
          "sourceDoc": "Q1-2026-Policy-Refresh",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "Concurrent use with CGRP allowed ONLY IF patient shows documented reduction in migraine days with CGRP but continues to experience significant/severe migraine days requiring additional therapy."
        }
      },
      "IN-PARTB-WPS": {
        "Neurotoxins": {
          "state": "IN",
          "payerName": "WPS GHA (IN)",
          "payerType": "Medicare MAC",
          "lob": "Part B",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "Strict 12-week frequency limit. Cosmetic concurrent use explicitly excluded. Exact conservative therapy failure methods must be documented; image guidance deemed unnecessary.",
          "step1Duration": "Documented",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Jurisdiction 5; LCD L39909 effective Feb 15 2026",
          "contraBypass": "Strict 12-week frequency limit. Cosmetic concurrent use explicitly excluded. Exact conservative therapy failure methods must be documented; image guidance deemed unnecessary.",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "LCD L39909",
          "sourceDoc": "Q1-2026-Policy-Refresh",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "Strict 12-week frequency limit. Cosmetic concurrent use explicitly excluded. Exact conservative therapy failure methods must be documented; image guidance deemed unnecessary."
        }
      },
      "WI-MCD-FWH": {
        "Gepants (Acute)": {
          "state": "WI",
          "payerName": "Wisconsin ForwardHealth",
          "payerType": "Medicaid FFS",
          "lob": "Medicaid",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "No (if dx code)",
          "step1Req": "Migraine diagnosis (G43.x)",
          "step1Duration": null,
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "⚠️ PROGRESSIVE: No PA required if ICD-10 = G43.x; PREFERRED: Nurtec ODT, Ubrelvy",
          "contraBypass": "N/A - dx-based approval",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "WI ForwardHealth PDL",
          "sourceDoc": "Wisconsin_2026_PA_Audit",
          "denialCode": "DENY-QL-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "CGRP mAbs (SC)": {
          "state": "WI",
          "payerName": "Wisconsin ForwardHealth",
          "payerType": "Medicaid FFS",
          "lob": "Medicaid",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes (for non-preferred)",
          "step1Req": "PREFERRED: Emgality/Nurtec/Qulipta; NON-PREFERRED: Aimovig/Ajovy require preferred failure",
          "step1Duration": null,
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "⚠️ 'Rule of 3' failure must be in chart; Vyepti = Non-Preferred (must fail preferred agents); 90-day Continuity for MCO transitions",
          "contraBypass": "Yes - preferred agent failure/intolerance",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "WI ForwardHealth PDL",
          "sourceDoc": "Wisconsin_2026_PA_Audit",
          "denialCode": "DENY-QL-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Neurotoxins": {
          "state": "WI",
          "payerName": "Wisconsin ForwardHealth",
          "payerType": "Medicaid FFS",
          "lob": "Medicaid",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "No (if dx code)",
          "step1Req": "Chronic Migraine diagnosis (G43.7x)",
          "step1Duration": null,
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "⚠️ No PA required if dx = G43.7x; 'Rule of 3' failure in chart documentation",
          "contraBypass": "N/A - dx-based approval",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "WI ForwardHealth PDL",
          "sourceDoc": "Wisconsin_2026_PA_Audit",
          "denialCode": "DENY-QL-001",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        }
      },
      "WI-COM-ANTHEM": {
        "Gepants (Acute)": {
          "state": "WI",
          "payerName": "Anthem BCBS Wisconsin",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 triptans",
          "step1Duration": "Documented",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Step 1; Ubrelvy often Tier 2; Nurtec Tier 3",
          "contraBypass": "Yes - CV contraindication",
          "goldCardAvail": "⚠️ SB 434 pending",
          "goldCardThresh": null,
          "policyId": "Anthem WI Formulary",
          "sourceDoc": "Wisconsin_2026_PA_Audit",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "CGRP mAbs (SC)": {
          "state": "WI",
          "payerName": "Anthem BCBS Wisconsin",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥1-2 oral classes (Beta-blocker/Topiramate)",
          "step1Duration": "≥8 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "PREFERRED: Emgality; Botox may require CGRP failure or adjunctive use",
          "contraBypass": "Yes - teratogenic; cognitive; respiratory",
          "goldCardAvail": "⚠️ SB 434 pending",
          "goldCardThresh": null,
          "policyId": "Anthem WI Formulary",
          "sourceDoc": "Wisconsin_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": "8.0",
          "episodicNotes": "Anthem: Episodic (<8d) = 1 oral class; Episodic (≥8d) = same as chronic (1 oral class). More lenient than most payers for episodic."
        }
      },
      "WI-COM-CGHC": {
        "CGRP mAbs (SC)": {
          "state": "WI",
          "payerName": "Common Ground Healthcare",
          "payerType": "Exchange",
          "lob": "Exchange",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral classes",
          "step1Duration": "≥8 weeks each",
          "step2Req": "≥1 preferred CGRP (Emgality/Aimovig)",
          "step2Duration": "Documented",
          "quantityLimit": "⚠️ Tier 4 Specialty (Non-Formulary); Step 2 = fail preferred CGRPs before others; strict EPO in-network",
          "contraBypass": "Yes - teratogenic; cognitive; respiratory",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "CGHC Formulary",
          "sourceDoc": "Wisconsin_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "WI-COM-DEAN": {
        "CGRP mAbs (SC)": {
          "state": "WI",
          "payerName": "Dean Health Plan (Medica)",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral classes",
          "step1Duration": "Documented",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "PREFERRED: Emgality, Aimovig; vertically integrated",
          "contraBypass": "Yes - teratogenic; cognitive; respiratory",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "Dean Formulary",
          "sourceDoc": "Wisconsin_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Neurotoxins": {
          "state": "WI",
          "payerName": "Dean Health Plan (Medica)",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥3 oral classes",
          "step1Duration": "Documented",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Higher threshold than others (3 vs 2 classes)",
          "contraBypass": "Yes - oral contraindications",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "Dean Policy",
          "sourceDoc": "Wisconsin_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        }
      },
      "WI-PARTB-NGS": {
        "Neurotoxins": {
          "state": "WI",
          "payerName": "National Government Services (WI)",
          "payerType": "Medicare MAC",
          "lob": "Part B",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥3 drug classes",
          "step1Duration": "Documented",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Jurisdiction 6 (WI/IL/MN); LCD L33646; >15 days/month; ⚠️ High documentation burden for IV necessity (Vyepti)",
          "contraBypass": "Yes - documented oral failures",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "LCD L33646",
          "sourceDoc": "Q1-2026-Policy-Refresh",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "updated clinical scales and longitudinal reassessment documentation requirements for Botulinum Toxin Injections"
        }
      },
      "IA-COM-WELLMARK": {
        "Gepants (Acute)": {
          "state": "IA",
          "payerName": "Wellmark BCBS Iowa",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 triptans",
          "step1Duration": "Documented",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "QL Ubrelvy 16/30d; Nurtec 15/30d; 'Vascular Contraindication' bypass",
          "contraBypass": "Yes - CV contraindication (HTN/arrhythmia/family hx MI)",
          "goldCardAvail": "⚠️ HF 303 pilot",
          "goldCardThresh": "90-95%",
          "policyId": "Wellmark Formulary",
          "sourceDoc": "Iowa_2026_PA_Audit",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "CGRP mAbs (SC)": {
          "state": "IA",
          "payerName": "Wellmark BCBS Iowa",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "Yes, requires trial and failure of BOTH preferred products (Ajovy and Emgality) prior to approval.",
          "step1Duration": "Documented",
          "step2Req": "⚠️ Aimovig = Non-Preferred; requires BOTH Ajovy AND Emgality failure ('double-step')",
          "step2Duration": "Documented",
          "quantityLimit": "PREFERRED: Ajovy, Emgality; ⚠️ 'MOA Argument' = if failed ligand-binder (Emgality), second ligand-binder (Ajovy) is redundant - switch to receptor-binder (Aimovig)",
          "contraBypass": "Yes - MOA bypass argument",
          "goldCardAvail": "⚠️ HF 303 pilot",
          "goldCardThresh": "90-95%",
          "policyId": "Wellmark Formulary",
          "sourceDoc": "Q1-2026-Policy-Refresh",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Neurotoxins": {
          "state": "IA",
          "payerName": "Wellmark BCBS Iowa",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes (Beta-blocker/TCA/AED)",
          "step1Duration": "Documented",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "15/8/4 rule; ⚠️ 'Clinically meaningful improvement' (not strict 50%); functional improvements OK (reduced ER visits/return to work)",
          "contraBypass": "Yes - oral contraindications",
          "goldCardAvail": "⚠️ HF 303 pilot",
          "goldCardThresh": "90-95%",
          "policyId": "Wellmark Policy",
          "sourceDoc": "Iowa_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        }
      },
      "IA-MCD-ITC": {
        "CGRP mAbs (SC)": {
          "state": "IA",
          "payerName": "Iowa Medicaid (Uniform PDL)",
          "payerType": "Medicaid",
          "lob": "Medicaid",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "Yes, requires documentation of three trials and therapy failures, of at least three months per agent (9 months total), at a maximally tolerated dose with a minimum of two different migraine prophylaxis drug classes.",
          "step1Duration": "Yes, requires documentation of three trials and therapy failures, of at least three months per agent (9 months total), at a maximally tolerated dose with a minimum of two different migraine prophylaxis drug classes.",
          "step2Req": null,
          "step2Duration": "Yes, requires documentation of three trials and therapy failures, of at least three months per agent (9 months total), at a maximally tolerated dose with a minimum of two different migraine prophylaxis drug classes.",
          "quantityLimit": "Uniform PDL across Iowa Total Care/Molina/Wellpoint",
          "contraBypass": "Yes - teratogenic; cognitive; respiratory",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "IA Uniform PDL",
          "sourceDoc": "Q1-2026-Policy-Refresh",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "IA-PARTB-WPS": {
        "Neurotoxins": {
          "state": "IA",
          "payerName": "WPS GHA (IA)",
          "payerType": "Medicare MAC",
          "lob": "Part B",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "LCD L39909 implemented. Requires >15 headache days/month, >8 migraine days/month. 2-month trial of at least 1 agent in 2 classes. Reauth requires >50% reduction in headache days/episodes. Allows concurrent CGRP use with documentation.",
          "step1Duration": "Documented",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Jurisdiction 5; LCD L39909",
          "contraBypass": "Yes - documented oral failures",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "LCD L39909",
          "sourceDoc": "Q1-2026-Policy-Refresh",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series.",
          "siteOfCare": "Same as IA-MAC-WPS — updated Botox LCD effective February 22, 2026 with tightened chronic migraine documentation requirements. Medical benefit. WPS GHA covers Iowa Part B."
        }
      },
      "MO-MCD-MHN": {
        "Gepants (Acute)": {
          "state": "MO",
          "payerName": "MO HealthNet (Medicaid)",
          "payerType": "Medicaid FFS",
          "lob": "Medicaid",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "Documented failure or ADE/ADR to Nurtec ODT",
          "step1Duration": "Documented",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "⚠️ NO preferred gepants without step; 'SmartPA' edit; Triptans = Tier 1; Zavzpret = higher scrutiny (all orals must fail)",
          "contraBypass": "Yes - CV contraindication; Serotonin Syndrome (SSRI/SNRI use)",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "MO PDL Edit",
          "sourceDoc": "Q1-2026-Policy-Refresh",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "CGRP mAbs (SC)": {
          "state": "MO",
          "payerName": "MO HealthNet (Medicaid)",
          "payerType": "Medicaid FFS",
          "lob": "Medicaid",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 prophylactic classes (Beta-blocker/TCA/AED)",
          "step1Duration": "Documented (4+ migraine days/month)",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "PREFERRED: Ajovy, Emgality 120mg; NON-PREFERRED: Aimovig; ⚠️ Vyepti = 'Step 3' (requires 2 preferred CGRP failure)",
          "contraBypass": "Yes - teratogenic; cognitive (Topiramate); hypotension; asthma; glaucoma",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "MO PDL",
          "sourceDoc": "Missouri_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Gepants (Preventive)": {
          "state": "MO",
          "payerName": "MO HealthNet (Medicaid)",
          "payerType": "Medicaid FFS",
          "lob": "Medicaid",
          "drugClass": "Gepants (Preventive)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "Injectable CGRP failure",
          "step1Duration": "Documented",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "⚠️ Nurtec preventive may require injectable failure first; needle phobia weak; injection site reactions stronger",
          "contraBypass": "Yes - injection site reactions; severe phobia",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "MO PDL",
          "sourceDoc": "Missouri_2026_PA_Audit",
          "denialCode": "DENY-QL-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "MO-COM-ANTHEM": {
        "CGRP mAbs (SC)": {
          "state": "MO",
          "payerName": "Anthem Missouri",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥1-2 oral preventive classes",
          "step1Duration": "≥2 months",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "PREFERRED: Emgality, Aimovig; ⚠️ Ajovy = excluded/exception required; Emgality 100mg = cluster headache indication (distinct)",
          "contraBypass": "Yes - teratogenic; intolerance (chest pressure/tightness/paresthesia)",
          "goldCardAvail": "⚠️ HB 618 resistant",
          "goldCardThresh": null,
          "policyId": "Anthem MO Formulary",
          "sourceDoc": "Missouri_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": "8.0",
          "episodicNotes": "Anthem: Episodic (<8d) = 1 oral class; Episodic (≥8d) = same as chronic (1 oral class). More lenient than most payers for episodic."
        }
      },
      "MO-COM-BLUEKC": {
        "CGRP mAbs (SC)": {
          "state": "MO",
          "payerName": "Blue Cross Blue Shield Kansas City",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral classes",
          "step1Duration": "Documented",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "⚠️ 2026 RESTRUCTURE: Ajovy EXCLUDED; Emgality moved lower tier; single-agent contracts; Continuity of Care appeals critical for non-medical switching",
          "contraBypass": "Yes - stability (Continuity of Care)",
          "goldCardAvail": "⚠️ HB 618 applies",
          "goldCardThresh": "90%",
          "policyId": "Blue KC Premium Formulary",
          "sourceDoc": "Missouri_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "MO-PARTB-WPS": {
        "Neurotoxins": {
          "state": "MO",
          "payerName": "WPS GHA (MO)",
          "payerType": "Medicare MAC",
          "lob": "Part B",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "Maximum dose 195 units; 2-month trial of 1 agent from 2 distinct prophylactic classes required",
          "step1Duration": "Documented",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Jurisdiction 5; ⚠️ LCD L39909 effective Feb 15 2026; MIDAS/HIT-6 MANDATORY; subjective documentation = recoupment risk",
          "contraBypass": "Yes - documented oral failures with validated scores",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "LCD L39909",
          "sourceDoc": "Q1-2026-Policy-Refresh",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        }
      },
      "TN-COM-BCBST": {
        "CGRP mAbs (SC)": {
          "state": "TN",
          "payerName": "BlueCross BlueShield Tennessee",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "≥8 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "PREFERRED: Emgality, Aimovig (Tier 3 with PA); strict step therapy exceeds AHS guidelines",
          "contraBypass": "Yes - teratogenic; cognitive; respiratory",
          "goldCardAvail": "⚠️ No state mandate (API focus)",
          "goldCardThresh": null,
          "policyId": "BCBST Essential Formulary",
          "sourceDoc": "Tennessee_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Gepants (Acute)": {
          "state": "TN",
          "payerName": "BlueCross BlueShield Tennessee",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 triptans",
          "step1Duration": "Documented",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Step therapy maintained; biosimilar push; TCA § 53-10-205 'Mandatory Generic' statute",
          "contraBypass": "Yes - CV contraindication",
          "goldCardAvail": "⚠️ No state mandate",
          "goldCardThresh": null,
          "policyId": "BCBST Formulary",
          "sourceDoc": "Tennessee_2026_PA_Audit",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "TN-MCD-WELLPOINT": {
        "CGRP mAbs (SC)": {
          "state": "TN",
          "payerName": "TennCare (All MCOs)",
          "payerType": "Medicaid",
          "lob": "Medicaid",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "≥8 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "TennCare PDL; harmonized across Wellpoint/UHC CP/BlueCare; generic triptans/oral preventives = Tier 1 mandate",
          "contraBypass": "Yes - teratogenic; cognitive; respiratory",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "TennCare PDL",
          "sourceDoc": "Tennessee_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Gepants (Acute)": {
          "state": "TN",
          "payerName": "TennCare (All MCOs)",
          "payerType": "Medicaid",
          "lob": "Medicaid",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 preferred triptans",
          "step1Duration": "Documented",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "⚠️ Split-benefit: Oral gepants = OptumRx State PBM (PDL); IV Vyepti = individual MCO medical policy",
          "contraBypass": "Yes - CV contraindication",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "TennCare PDL",
          "sourceDoc": "Tennessee_2026_PA_Audit",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "TN-PARTB-PALMETTO": {
        "Neurotoxins": {
          "state": "TN",
          "payerName": "Palmetto GBA (TN)",
          "payerType": "Medicare MAC",
          "lob": "Part B",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "Conservative therapy failure + headache diary",
          "step1Duration": "Documented",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Jurisdiction M; LCD L33458/DL39909; ⚠️ Strict 84-day (12-week) frequency cap; >15 days + >4 hours documented in diary; automated denial if even 1 day early",
          "contraBypass": "Yes - documented oral failures with diary",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "LCD L33458/DL39909",
          "sourceDoc": "Tennessee_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        }
      },
      "KY-COM-ANTHEM": {
        "CGRP mAbs (SC)": {
          "state": "KY",
          "payerName": "Anthem Kentucky",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes (generic first)",
          "step1Duration": "≥8 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "⚠️ 69% market = state standard; Tier 3 specialty gated; fail-first rigidly enforced",
          "contraBypass": "Yes - teratogenic; cognitive; respiratory",
          "goldCardAvail": "⚠️ HB 135/317 FAILED",
          "goldCardThresh": null,
          "policyId": "Anthem KY Formulary",
          "sourceDoc": "Kentucky_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": "8.0",
          "episodicNotes": "Anthem: Episodic (<8d) = 1 oral class; Episodic (≥8d) = same as chronic (1 oral class). More lenient than most payers for episodic."
        },
        "Gepants (Acute)": {
          "state": "KY",
          "payerName": "Anthem Kentucky",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 generic triptans",
          "step1Duration": "Documented",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Cost differential ($0.50-$1 triptan vs $100+ gepant) drives rigid fail-first",
          "contraBypass": "Yes - CV contraindication",
          "goldCardAvail": "⚠️ HB 135/317 FAILED",
          "goldCardThresh": null,
          "policyId": "Anthem KY Formulary",
          "sourceDoc": "Kentucky_2026_PA_Audit",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Gepants (Preventive)": {
          "state": "KY",
          "payerName": "Anthem Kentucky",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Preventive)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "Fail oral preventives (Tier 3 specialty step)",
          "step1Duration": "≥8 weeks",
          "step2Req": "Inferred: Similar to CGRP mAb",
          "step2Duration": null,
          "quantityLimit": "30 tabs/30 days",
          "contraBypass": "Yes - CGRP mechanism different from triptans",
          "goldCardAvail": "No",
          "goldCardThresh": null,
          "policyId": null,
          "sourceDoc": "Kentucky_2026_PA_Audit.md",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "FALLBACK from CGRP mAb baseline"
        }
      },
      "KY-MCD-AETNA": {
        "CGRP mAbs (SC)": {
          "state": "KY",
          "payerName": "Kentucky Medicaid (Unified PDL)",
          "payerType": "Medicaid",
          "lob": "Medicaid",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "≥8 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "⚠️ Unified PDL standardizes pharmacy across all MCOs (Aetna/Humana/Passport/WellCare/UHC); medical benefit = MCO-specific",
          "contraBypass": "Yes - teratogenic; cognitive; respiratory",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "KY Unified PDL",
          "sourceDoc": "Q1-2026-Policy-Refresh",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "Concurrent use of 2 or more CGRP inhibitors is prohibited. Soft edit placed on Nurtec ODT requiring pharmacist override to ensure non-duplication of acute and preventive therapies."
        },
        "Gepants (Acute)": {
          "state": "KY",
          "payerName": "Kentucky Medicaid (Unified PDL)",
          "payerType": "Medicaid",
          "lob": "Medicaid",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 preferred triptans",
          "step1Duration": "Documented",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Dual-track PA: oral Rimegepant = state PDL; IV Eptinezumab = MCO medical policy",
          "contraBypass": "Yes - CV contraindication",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "KY Unified PDL",
          "sourceDoc": "Kentucky_2026_PA_Audit",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "KY-PARTB-CGS": {
        "Neurotoxins": {
          "state": "KY",
          "payerName": "CGS Administrators (KY)",
          "payerType": "Medicare MAC",
          "lob": "Part B",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "Conservative therapy failure",
          "step1Duration": "Documented",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Jurisdiction 15; LCD L33949; 'reasonable and necessary' standard; bound by Social Security Act",
          "contraBypass": "Yes - documented oral failures",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "LCD L33949",
          "sourceDoc": "Kentucky_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        }
      },
      "AL-MCD-AMA": {
        "CGRP mAbs (SC)": {
          "state": "AL",
          "payerName": "Alabama Medicaid Agency",
          "payerType": "Medicaid FFS",
          "lob": "Medicaid",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "⚠️ 'Fail 2 Rule': 2 different oral preventive classes",
          "step1Duration": "≥8 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "'Preferred with Clinical Criteria (CC)' = PA required; PREFERRED: Aimovig, Ajovy, Emgality, Qulipta; NON-PREFERRED: Vyepti (requires SC failure); ⚠️ Form 369 MANDATORY via Acentra Health",
          "contraBypass": "Yes - teratogenic; cognitive; respiratory",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "Alabama PDL CC",
          "sourceDoc": "Alabama_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Gepants (Acute)": {
          "state": "AL",
          "payerName": "Alabama Medicaid Agency",
          "payerType": "Medicaid FFS",
          "lob": "Medicaid",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 triptans",
          "step1Duration": "Documented",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "PREFERRED with CC: Ubrelvy, Nurtec ODT; NON-PREFERRED: Zavzpret; verify acute vs preventive indication on Form 369",
          "contraBypass": "Yes - CV contraindication; Serotonin Syndrome",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "Alabama PDL CC",
          "sourceDoc": "Alabama_2026_PA_Audit",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "AL-PARTB-PALMETTO": {
        "Neurotoxins": {
          "state": "AL",
          "payerName": "Palmetto GBA (AL)",
          "payerType": "Medicare MAC",
          "lob": "Part B",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "Conservative therapy failure",
          "step1Duration": "Documented",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Jurisdiction J; ⚠️ LCD DL39909 Feb 15 2026 'Documentation Cliff' - ICD-10 specificity required; unspecified migraine codes = denial risk",
          "contraBypass": "Yes - documented oral failures",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "LCD DL39909",
          "sourceDoc": "Alabama_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        }
      },
      "SC-COM-BCBSSC": {
        "CGRP mAbs (SC)": {
          "state": "SC",
          "payerName": "BlueCross BlueShield SC",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "≥8 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "⚠️ PEBA State Health Plan = CVS Caremark (NEW Jan 2026); Commercial = Prime Therapeutics; distinct formularies; 'continuation of care' denials expected Q1 2026",
          "contraBypass": "Yes - teratogenic; cognitive; respiratory",
          "goldCardAvail": "⚠️ S. 531 pending",
          "goldCardThresh": null,
          "policyId": "BCBSSC Formulary",
          "sourceDoc": "South_Carolina_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Gepants (Acute)": {
          "state": "SC",
          "payerName": "BlueCross BlueShield SC",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 triptans",
          "step1Duration": "Documented",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Step therapy to maximize MLR; generic triptans vs high-cost specialty",
          "contraBypass": "Yes - CV contraindication",
          "goldCardAvail": "⚠️ S. 531 pending",
          "goldCardThresh": null,
          "policyId": "BCBSSC Formulary",
          "sourceDoc": "South_Carolina_2026_PA_Audit",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "SC-MCD-SCDHHS": {
        "CGRP mAbs (SC)": {
          "state": "SC",
          "payerName": "SC Medicaid (Unified PDL)",
          "payerType": "Medicaid",
          "lob": "Medicaid",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "≥8 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "⚠️ 'One PDL' policy = all MCOs (First Choice/Absolute/Molina/Humana/Healthy Blue) follow FFS list; no MCO flexibility; rebate maximization",
          "contraBypass": "Yes - teratogenic; cognitive; respiratory",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "SC Unified PDL",
          "sourceDoc": "South_Carolina_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Gepants (Acute)": {
          "state": "SC",
          "payerName": "SC Medicaid (Unified PDL)",
          "payerType": "Medicaid",
          "lob": "Medicaid",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 preferred triptans",
          "step1Duration": "Documented",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Unified PDL; pharmacy = Magellan Rx (FFS); medical J-codes = MCO-specific",
          "contraBypass": "Yes - CV contraindication",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "SC Unified PDL",
          "sourceDoc": "South_Carolina_2026_PA_Audit",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "SC-PARTB-PALMETTO": {
        "Neurotoxins": {
          "state": "SC",
          "payerName": "Palmetto GBA (SC)",
          "payerType": "Medicare MAC",
          "lob": "Part B",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "Conservative therapy failure",
          "step1Duration": "Documented",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Jurisdiction J/M; HQ Columbia SC; LCD L33458; quasi-law for Medicare Part B; documentation must meet specific LCD elements or claim denied/recouped",
          "contraBypass": "Allowed with documentation of \"further reduction\" in MMD",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "LCD L33458",
          "sourceDoc": "Q1-2026-Policy-Refresh",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        }
      },
      "LA-COM-BCBSLA": {
        "CGRP mAbs (SC)": {
          "state": "LA",
          "payerName": "Blue Cross Blue Shield Louisiana",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "No",
          "step1Req": "⚠️ FIRST-LINE VICTORY: No oral preventive failure required (AHS 2024 aligned)",
          "step1Duration": null,
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "~66% market share; policies = local standard of care; Act 432 applies to medical benefit (CPT 64615/J3032)",
          "contraBypass": "N/A - First-Line",
          "goldCardAvail": "✓ Act 432 (medical only)",
          "goldCardThresh": "90%",
          "policyId": "BCBSLA Policy",
          "sourceDoc": "Louisiana_2026_PA_Audit",
          "denialCode": "DENY-FIRST-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Gepants (Acute)": {
          "state": "LA",
          "payerName": "Blue Cross Blue Shield Louisiana",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 triptans (expected)",
          "step1Duration": "Documented",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "⚠️ Act 432 excludes 'pharmacy services' - oral gepants NOT Gold Card eligible; Part D cap ($2,000) increases payer UM on Part D drugs",
          "contraBypass": "Yes - CV contraindication",
          "goldCardAvail": "⚠️ Act 432 excludes pharmacy",
          "goldCardThresh": null,
          "policyId": "BCBSLA Formulary",
          "sourceDoc": "Louisiana_2026_PA_Audit",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "LA-MCD-LHC": {
        "CGRP mAbs (SC)": {
          "state": "LA",
          "payerName": "Louisiana Medicaid (Single PDL)",
          "payerType": "Medicaid",
          "lob": "Medicaid",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "≥8 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "LDH Single PDL; all MCOs (LA Healthcare Connections/Healthy Blue) follow state list; InterQual criteria where state silent",
          "contraBypass": "Yes - teratogenic; cognitive; respiratory",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "LA Single PDL",
          "sourceDoc": "Louisiana_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Gepants (Acute)": {
          "state": "LA",
          "payerName": "Louisiana Medicaid (Single PDL)",
          "payerType": "Medicaid",
          "lob": "Medicaid",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 preferred triptans",
          "step1Duration": "Documented",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Single PDL; MCO-specific medical policies for J-codes",
          "contraBypass": "Yes - CV contraindication",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "LA Single PDL",
          "sourceDoc": "Louisiana_2026_PA_Audit",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "LA-PARTB-NOVITAS": {
        "Neurotoxins": {
          "state": "LA",
          "payerName": "Novitas Solutions (LA)",
          "payerType": "Medicare MAC",
          "lob": "Part B",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "Conservative therapy failure + functional improvement metrics",
          "step1Duration": "Documented",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Jurisdiction H; LCD L38809; ⚠️ Functional improvement metrics tightened for 2026; objective documentation required",
          "contraBypass": "Yes - documented oral failures with improvement metrics",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "LCD L38809",
          "sourceDoc": "Q1-2026-Policy-Refresh",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "episodicSameAsChronic = No; Strict diagnostic evidence of 15+ headache days/month lasting 4+ hours required. Maintenance requires documented clinical effectiveness over 2 prior treatments (12-week intervals)."
        }
      },
      "AK-COM-PREMERA": {
        "Gepants (Acute)": {
          "state": "AK",
          "payerName": "Premera BCBS Alaska",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 preferred triptans (Sumatriptan/Rizatriptan)",
          "step1Duration": "Documented",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "QL 16-18 doses/30 days; higher QL requires headache diary; Tier 3 Non-Preferred on B4/M4 formularies",
          "contraBypass": "Yes - CV contraindication (CAD/PVD/HTN/hemiplegic/basilar)",
          "goldCardAvail": "⚠️ SB 133 effective 2027",
          "goldCardThresh": null,
          "policyId": "Policy 5.01.503",
          "sourceDoc": "Alaska_2026_PA_Audit",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "CGRP mAbs (SC)": {
          "state": "AK",
          "payerName": "Premera BCBS Alaska",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 categories traditional prophylaxis",
          "step1Duration": "≥8 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Policy 5.01.584; Vyepti Site of Service review (HOPD denied unless medically necessary); pediatric Ajovy (12-17) available",
          "contraBypass": "Yes - teratogenic; cognitive; respiratory; hypotension",
          "goldCardAvail": "⚠️ SB 133 effective 2027",
          "goldCardThresh": null,
          "policyId": "Policy 5.01.584",
          "sourceDoc": "Alaska_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Gepants (Preventive)": {
          "state": "AK",
          "payerName": "Premera",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Preventive)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 preventive classes",
          "step1Duration": "≥2 months",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "16 tabs/30 days",
          "contraBypass": "Yes - standard CGRP bypasses",
          "goldCardAvail": "No",
          "goldCardThresh": null,
          "policyId": null,
          "sourceDoc": "Alaska_2026_PA_Audit.md",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "High-cost preventive - accelerates OOP cap"
        }
      },
      "AK-PARTB-NORIDIAN": {
        "Neurotoxins": {
          "state": "AK",
          "payerName": "Noridian Healthcare Solutions (AK)",
          "payerType": "Medicare MAC",
          "lob": "Part B",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "Conservative therapy failure",
          "step1Duration": "Failure of at least one agent in any two specified classes (antidepressants, beta blockers, CCBs, antiepileptics) for a minimum of two months each.",
          "step2Req": null,
          "step2Duration": "Failure of at least one agent in any two specified classes (antidepressants, beta blockers, CCBs, antiepileptics) for a minimum of two months each.",
          "quantityLimit": "Jurisdiction F; LCD L35172; J-code specific billing; JW modifiers required",
          "contraBypass": "Yes - documented oral failures",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "LCD L35172",
          "sourceDoc": "Q1-2026-Policy-Refresh",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        }
      },
      "HI-MCD-ALOHACARE": {
        "CGRP mAbs (SC)": {
          "state": "HI",
          "payerName": "AlohaCare Hawaii",
          "payerType": "Medicaid/SNP",
          "lob": "Medicaid",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "≥8 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Mirrors state FFS criteria with MCO overlays; QUEST + Medicare SNP focus",
          "contraBypass": "Yes - teratogenic; cognitive; respiratory",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "AlohaCare Policy",
          "sourceDoc": "Hawaii_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "HI-PARTB-NORIDIAN": {
        "Neurotoxins": {
          "state": "HI",
          "payerName": "Noridian Healthcare Solutions (HI)",
          "payerType": "Medicare MAC",
          "lob": "Part B",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "Same as HI-MAC-NORIDIAN — updated Botox LCD effective February 22, 2026 with tightened chronic migraine documentation requirements. Medical benefit. Noridian Jurisdiction F covers Hawaii Part B.",
          "step1Duration": "Documented",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Jurisdiction E; LCD for Botox/Vyepti",
          "contraBypass": "Yes - documented oral failures",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "Noridian LCD",
          "sourceDoc": "Q1-2026-Policy-Refresh",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "Final LCD L35170 explicitly requires objective documentation of CGRP therapy if used concurrently",
          "siteOfCare": "Same as HI-MAC-NORIDIAN — updated Botox LCD effective February 22, 2026 with tightened chronic migraine documentation requirements. Medical benefit. Noridian Jurisdiction F covers Hawaii Part B."
        }
      },
      "ID-COM-BCI": {
        "Gepants (Acute)": {
          "state": "ID",
          "payerName": "Blue Cross of Idaho",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 generic triptans",
          "step1Duration": "Documented",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "~42-44% market; MP 5.01.501; highest ROI for template alignment",
          "contraBypass": "Yes - CV contraindication",
          "goldCardAvail": "⚠️ HB 618 stalled",
          "goldCardThresh": null,
          "policyId": "MP 5.01.501",
          "sourceDoc": "Idaho_2026_PA_Audit",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "CGRP mAbs (SC)": {
          "state": "ID",
          "payerName": "Blue Cross of Idaho",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "≥8 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Sets clinical policy 'thermostat' for region; Prime Therapeutics PBM",
          "contraBypass": "Yes - teratogenic; cognitive; respiratory",
          "goldCardAvail": "⚠️ HB 618 stalled",
          "goldCardThresh": null,
          "policyId": "MP 5.01.501",
          "sourceDoc": "Idaho_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "ID-COM-REGENCE": {
        "CGRP mAbs (SC)": {
          "state": "ID",
          "payerName": "Regence BlueShield Idaho",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "≥8 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Cambia regional policies; more restrictive on 'investigational' combos; rigid pharmacy/medical separation; Ajovy procurement nuances",
          "contraBypass": "Yes - teratogenic; cognitive; respiratory",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "Regence Policy",
          "sourceDoc": "Idaho_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "ID-COM-SELECTHEALTH": {
        "CGRP mAbs (SC)": {
          "state": "ID",
          "payerName": "SelectHealth Idaho",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "⚠️ ≥8 weeks each (stricter than 4-week competitors)",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Intermountain vertically integrated; system-wide cost-effectiveness; stricter durations",
          "contraBypass": "Yes - teratogenic; cognitive; respiratory",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "SelectHealth Policy",
          "sourceDoc": "Idaho_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "ID-MCD-DHW": {
        "CGRP mAbs (SC)": {
          "state": "ID",
          "payerName": "Idaho Medicaid (FFS/MCO)",
          "payerType": "Medicaid",
          "lob": "Medicaid",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥1-2 oral preventive classes",
          "step1Duration": "Documented",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "⚠️ HB 345 DUAL-TRACK: FFS via Prime Therapeutics; MCO via Molina/UHC CP (distinct criteria divergence); QL overrides may be needed",
          "contraBypass": "Yes - teratogenic; cognitive; respiratory",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "ID PDL",
          "sourceDoc": "Idaho_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "ID-PARTB-NORIDIAN": {
        "Neurotoxins": {
          "state": "ID",
          "payerName": "Noridian Healthcare Solutions (ID)",
          "payerType": "Medicare MAC",
          "lob": "Part B",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "Same as ID-MAC-NORIDIAN — updated Botox LCD effective February 22, 2026 with tightened chronic migraine documentation requirements. Medical benefit. Noridian Jurisdiction E covers Idaho Part B.",
          "step1Duration": "Documented",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Jurisdiction F; ⚠️ LCD DL39909 effective early 2026; subjective relief insufficient; quantifiable improvement required",
          "contraBypass": "Yes - documented oral failures with objective metrics",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "LCD DL39909",
          "sourceDoc": "Q1-2026-Policy-Refresh",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series.",
          "siteOfCare": "Same as ID-MAC-NORIDIAN — updated Botox LCD effective February 22, 2026 with tightened chronic migraine documentation requirements. Medical benefit. Noridian Jurisdiction E covers Idaho Part B."
        }
      },
      "MT-MCD-DPHHS": {
        "CGRP mAbs (SC)": {
          "state": "MT",
          "payerName": "Montana Medicaid",
          "payerType": "Medicaid FFS",
          "lob": "Medicaid",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "≥8 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Mountain-Pacific QIO; strict PDL adherence; SB 449 continuity applies",
          "contraBypass": "Yes - teratogenic; cognitive; respiratory",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "MT PDL",
          "sourceDoc": "Montana_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "MT-COM-PACIFICSOURCE": {
        "CGRP mAbs (SC)": {
          "state": "MT",
          "payerName": "PacificSource Montana",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "≥8 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "CVS Caremark vertical integration; rigorous step therapy",
          "contraBypass": "Yes - teratogenic; cognitive; respiratory",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "PacificSource Formulary",
          "sourceDoc": "Montana_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "MT-PARTB-NORIDIAN": {
        "Neurotoxins": {
          "state": "MT",
          "payerName": "Noridian Healthcare Solutions (MT)",
          "payerType": "Medicare MAC",
          "lob": "Part B",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "Conservative therapy failure",
          "step1Duration": "Documented",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Jurisdiction F; LCD DL39909",
          "contraBypass": "Yes - documented oral failures",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "LCD DL39909",
          "sourceDoc": "Montana_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        }
      },
      "WY-COM-BCBSWY": {
        "Gepants (Acute)": {
          "state": "WY",
          "payerName": "Blue Cross Blue Shield Wyoming",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "Explicit addition of \"triptan combination agents\" to the step requirement for acute migraine therapy",
          "step1Duration": "Documented",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Duopoly market; ⚠️ W.S. § 26-55-112 EXCLUDES PHARMACY - oral meds NOT Gold Card eligible",
          "contraBypass": "Yes - CV contraindication",
          "goldCardAvail": "✓ W.S. § 26-55-112 (medical only)",
          "goldCardThresh": "90%",
          "policyId": "BCBSWY Formulary",
          "sourceDoc": "Q1-2026-Policy-Refresh",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "CGRP mAbs (SC)": {
          "state": "WY",
          "payerName": "Blue Cross Blue Shield Wyoming",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "≥8 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "⚠️ J-code ambiguity: administration (CPT 64615) may be Gold Carded but drug product (J0585) may still need PA",
          "contraBypass": "Yes - teratogenic; cognitive; respiratory",
          "goldCardAvail": "✓ W.S. § 26-55-112 (medical only)",
          "goldCardThresh": "90%",
          "policyId": "BCBSWY Formulary",
          "sourceDoc": "Wyoming_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "WY-MCD-DHF": {
        "CGRP mAbs (SC)": {
          "state": "WY",
          "payerName": "Wyoming Medicaid",
          "payerType": "Medicaid FFS",
          "lob": "Medicaid",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "≥8 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Step therapy portability honored (no repeat if failed under previous plan); 1-year auth validity for chronic conditions",
          "contraBypass": "Yes - teratogenic; cognitive; respiratory",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "WY PDL",
          "sourceDoc": "Wyoming_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Neurotoxins": {
          "state": "WY",
          "payerName": "Wyoming Medicaid",
          "payerType": "Medicaid FFS",
          "lob": "Medicaid",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "⚠️ 2026 REVERSAL: Must fail CGRP inhibitor BEFORE Botox",
          "step1Duration": "Documented CGRP failure",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Reversed traditional therapeutic hierarchy; CGRP first, then Botox",
          "contraBypass": "Yes - CGRP contraindication/failure",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "WY PDL",
          "sourceDoc": "Wyoming_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        }
      },
      "WY-PARTB-NORIDIAN": {
        "Neurotoxins": {
          "state": "WY",
          "payerName": "Noridian Healthcare Solutions (WY)",
          "payerType": "Medicare MAC",
          "lob": "Part B",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "Conservative therapy failure",
          "step1Duration": "Documented",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Jurisdiction F; LCD DL39909",
          "contraBypass": "Yes - documented oral failures",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "LCD DL39909",
          "sourceDoc": "Wyoming_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        }
      },
      "KS-COM-BCBSKS": {
        "Gepants (Acute)": {
          "state": "KS",
          "payerName": "Blue Cross Blue Shield Kansas",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 generic triptans (explicit dates required)",
          "step1Duration": "Documented failure",
          "step2Req": "'Triptan Wall' - specific dates of failure required",
          "step2Duration": null,
          "quantityLimit": "QL 16 tabs/30d; specialty tiering 2026",
          "contraBypass": "Yes - CV contraindication",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "BCBSKS Formulary",
          "sourceDoc": "Kansas_PA_Audit",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "CGRP mAbs (SC)": {
          "state": "KS",
          "payerName": "Blue Cross Blue Shield Kansas",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "Documented",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "ICHD-3 criteria; MIDAS/HIT-6 quantitative metrics required",
          "contraBypass": "Yes - teratogenic; cognitive; respiratory",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "BCBSKS Formulary",
          "sourceDoc": "Kansas_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "KS-PARTB-WPS": {
        "Neurotoxins": {
          "state": "KS",
          "payerName": "WPS GHA (KS)",
          "payerType": "Medicare MAC",
          "lob": "Part B",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "Conservative therapy failure",
          "step1Duration": "Documented",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Jurisdiction 5; LCD DL39909; specific dx codes mandatory; rigid injection intervals; ICHD-3 15/8 alignment",
          "contraBypass": "Yes - documented oral failures",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "LCD DL39909",
          "sourceDoc": "Q1-2026-Policy-Refresh",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "LCD L39909 mandates highly specific documentation detailing the exact conservative methods completed and clinical assessment of intolerance or inadequate response."
        }
      },
      "NE-COM-BCBSNE": {
        "Gepants (Acute)": {
          "state": "NE",
          "payerName": "Blue Cross Blue Shield Nebraska",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 generic triptans",
          "step1Duration": "Documented",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Tier 2/3 Preferred; QL typical; Prime Therapeutics PBM logic",
          "contraBypass": "Yes - CV contraindication",
          "goldCardAvail": "⚠️ No statutory Gold Card",
          "goldCardThresh": null,
          "policyId": "BCBSNE Formulary",
          "sourceDoc": "Nebraska_2026_PA_Audit",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "CGRP mAbs (SC)": {
          "state": "NE",
          "payerName": "Blue Cross Blue Shield Nebraska",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥1-2 oral preventive classes",
          "step1Duration": "Documented",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "PREFERRED: Aimovig, Emgality; NON-PREFERRED: Ajovy; Medical Policy M.29 for Botox",
          "contraBypass": "Yes - teratogenic; cognitive; respiratory",
          "goldCardAvail": "⚠️ No statutory Gold Card",
          "goldCardThresh": null,
          "policyId": "BCBSNE Formulary",
          "sourceDoc": "Nebraska_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "NE-PARTB-WPS": {
        "Neurotoxins": {
          "state": "NE",
          "payerName": "WPS GHA (NE)",
          "payerType": "Medicare MAC",
          "lob": "Part B",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "Concurrent CGRP allowed with documented reduction in severity/days / 50% reduction in migraine days required for continuation / Initial dose strict 155 units",
          "step1Duration": "Documented",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Jurisdiction 5; LCD DL39909 effective Feb 15 2026; granular injection site/dosage documentation; targeted injections required",
          "contraBypass": "Concurrent CGRP allowed with documented reduction in severity/days / 50% reduction in migraine days required for continuation / Initial dose strict 155 units",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "LCD DL39909",
          "sourceDoc": "Q1-2026-Policy-Refresh",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "Concurrent CGRP allowed with documented reduction in severity/days / 50% reduction in migraine days required for continuation / Initial dose strict 155 units"
        }
      },
      "ND-COM-BCBSND": {
        "Gepants (Acute)": {
          "state": "ND",
          "payerName": "Blue Cross Blue Shield North Dakota",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 triptans",
          "step1Duration": "Documented",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Standard step therapy maintained for acute",
          "contraBypass": "Yes - CV contraindication",
          "goldCardAvail": "✓ SB 2280 Gold Card",
          "goldCardThresh": "90%",
          "policyId": "BCBSND Formulary",
          "sourceDoc": "North_Dakota_2026_PA_Audit",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "CGRP mAbs (SC)": {
          "state": "ND",
          "payerName": "Blue Cross Blue Shield North Dakota",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "No (Chronic)",
          "step1Req": "⚠️ FIRST-LINE for Chronic Migraine (Jan 2026 policy update); oral step REMOVED",
          "step1Duration": "N/A for Chronic; Episodic may still need step",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "⚠️ MAJOR WIN: AHS 2024 aligned; cite 'January 2026 Policy Update' in appeals to override legacy PBM auto-rejections",
          "contraBypass": "N/A - First-Line (Chronic)",
          "goldCardAvail": "✓ SB 2280 Gold Card",
          "goldCardThresh": "90%",
          "policyId": "BCBSND Policy Update Jan 2026",
          "sourceDoc": "North_Dakota_2026_PA_Audit",
          "denialCode": "DENY-QL-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "ND-MCD-DHS": {
        "Gepants (Acute)": {
          "state": "ND",
          "payerName": "North Dakota Medicaid",
          "payerType": "Medicaid FFS",
          "lob": "Medicaid",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "Failed 30-day trial of two triptans (one nasal) and failed 30-day trial of Nurtec ODT, Ubrelvy, and Reyvow",
          "step1Duration": "Documented",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Acentra Health PA reviews; strict",
          "contraBypass": "Yes - CV contraindication",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "ND PDL",
          "sourceDoc": "Q1-2026-Policy-Refresh",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "CGRP mAbs (SC)": {
          "state": "ND",
          "payerName": "North Dakota Medicaid",
          "payerType": "Medicaid FFS",
          "lob": "Medicaid",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "⚠️ Fail 2 Triptans + Fail 2 Oral Preventives",
          "step1Duration": "Documented",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "No liberalization like commercial; strict FFS criteria maintained",
          "contraBypass": "Yes - teratogenic; cognitive; respiratory",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "ND PDL",
          "sourceDoc": "North_Dakota_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "ND-PARTB-NORIDIAN": {
        "Neurotoxins": {
          "state": "ND",
          "payerName": "Noridian Healthcare Solutions (ND)",
          "payerType": "Medicare MAC",
          "lob": "Part B",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "Inadequate response to at least one agent in two classes of completed medications",
          "step1Duration": "Documented",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Jurisdiction F; LCD DL39909/L35172; ⚠️ 15/8 threshold RIGID; zero tolerance for 'frequent headaches' ambiguity; must specify migraine vs headache days",
          "contraBypass": "Yes - documented oral failures",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "LCD DL39909/L35172",
          "sourceDoc": "Q1-2026-Policy-Refresh",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "Documentation of concurrent or previous CGRP therapy required"
        }
      },
      "SD-MCD-DSS": {
        "Gepants (Acute)": {
          "state": "SD",
          "payerName": "South Dakota Medicaid",
          "payerType": "Medicaid FFS",
          "lob": "Medicaid",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 triptans",
          "step1Duration": "Documented",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "PREFERRED: Ubrelvy; Optum/OptumRx admin",
          "contraBypass": "Yes - CV contraindication",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "SD PDL",
          "sourceDoc": "South_Dakota_2026_PA_Audit",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "CGRP mAbs (SC)": {
          "state": "SD",
          "payerName": "South Dakota Medicaid",
          "payerType": "Medicaid FFS",
          "lob": "Medicaid",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥1 traditional preventive",
          "step1Duration": "≥8 weeks",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "PREFERRED: Aimovig, Emgality; NON-PREFERRED: Ajovy; Nurtec preventive = TBD",
          "contraBypass": "Yes - teratogenic; cognitive; respiratory",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "SD PDL",
          "sourceDoc": "South_Dakota_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "SD-PARTB-NORIDIAN": {
        "Neurotoxins": {
          "state": "SD",
          "payerName": "Noridian Healthcare Solutions (SD)",
          "payerType": "Medicare MAC",
          "lob": "Part B",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "step1Req: Inadequate response/contraindication to at least one agent in any two of the following classes: Antidepressants, Beta blockers, Calcium channel blockers. step1Duration: 2 months (8 weeks).",
          "step1Duration": "step1Req: Inadequate response/contraindication to at least one agent in any two of the following classes: Antidepressants, Beta blockers, Calcium channel blockers. step1Duration: 2 months (8 weeks).",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Jurisdiction F; LCD DL39909",
          "contraBypass": "Yes - documented oral failures",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "LCD DL39909",
          "sourceDoc": "Q1-2026-Policy-Refresh",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        }
      },
      "OK-COM-UHC": {
        "CGRP mAbs (SC)": {
          "state": "OK",
          "payerName": "UnitedHealthcare Oklahoma",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventives",
          "step1Duration": "≥2 months",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "⚠️ Qulipta may require injectable CGRP failure first; HB 1808 criteria posting mandate",
          "contraBypass": "Yes - teratogenic; cognitive; respiratory",
          "goldCardAvail": "✓ National Gold Card + HB 1808",
          "goldCardThresh": "92%",
          "policyId": "UHC Policy",
          "sourceDoc": "Oklahoma_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Gepants (Preventive)": {
          "state": "OK",
          "payerName": "UHC",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Preventive)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventives",
          "step1Duration": "≥2 months each",
          "step2Req": "Fail Aimovig/Emgality",
          "step2Duration": null,
          "quantityLimit": "30 tabs/30 days",
          "contraBypass": "Yes - needle phobia documented",
          "goldCardAvail": "No",
          "goldCardThresh": null,
          "policyId": null,
          "sourceDoc": "Oklahoma_2026_PA_Audit.md",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "Double step - behind oral AND mAb"
        }
      },
      "OK-COM-AETNA": {
        "Gepants (Acute)": {
          "state": "OK",
          "payerName": "Aetna Oklahoma",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 triptans",
          "step1Duration": "Documented",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Policy 3481-E; CVS Caremark",
          "contraBypass": "Yes - CV contraindication",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "Policy 3481-E",
          "sourceDoc": "Oklahoma_2026_PA_Audit",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "CGRP mAbs (SC)": {
          "state": "OK",
          "payerName": "Aetna Oklahoma",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventives",
          "step1Duration": "60-day trial each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "CPB 2761-E",
          "contraBypass": "Yes - teratogenic; cognitive; respiratory",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "CPB 2761-E",
          "sourceDoc": "Oklahoma_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "OK-PARTB-NOVITAS": {
        "Neurotoxins": {
          "state": "OK",
          "payerName": "Novitas Solutions (OK)",
          "payerType": "Medicare MAC",
          "lob": "Part B",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "Conservative therapy failure",
          "step1Duration": "Documented",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Jurisdiction H; LCD L35170; ⚠️ Chronic Migraine ONLY; >15 days/mo strict; excludes episodic use; injection site documentation",
          "contraBypass": "Yes - documented oral failures",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "LCD L35170",
          "sourceDoc": "Oklahoma_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        }
      },
      "AR-COM-ABCBS": {
        "Gepants (Acute)": {
          "state": "AR",
          "payerName": "Arkansas BCBS (ABCBS)",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 triptans (failure of efficacy at max tolerated doses or intolerance)",
          "step1Duration": "Documented",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Tier 3 (ST+QL); 'Triptan Failure' definition tightened 2026",
          "contraBypass": "Yes - CV contraindication",
          "goldCardAvail": "✓ Act 575 Gold Card",
          "goldCardThresh": "90%",
          "policyId": "ABCBS Formulary",
          "sourceDoc": "Arkansas_2026_PA_Audit",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "CGRP mAbs (SC)": {
          "state": "AR",
          "payerName": "Arkansas BCBS (ABCBS)",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "≥8 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Aimovig/Emgality = Preferred; Vyepti = 2 oral + 1 SC mAb failure; ⚠️ 30% HA reduction at 6mo 'Stopping Rule'",
          "contraBypass": "Yes - teratogenic; cognitive; respiratory",
          "goldCardAvail": "✓ Act 575 Gold Card",
          "goldCardThresh": "90%",
          "policyId": "ABCBS Formulary",
          "sourceDoc": "Arkansas_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "AR-MCD-DHS": {
        "Gepants (Acute)": {
          "state": "AR",
          "payerName": "Arkansas Medicaid (FFS/PASSE)",
          "payerType": "Medicaid",
          "lob": "Medicaid",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 preferred triptans",
          "step1Duration": "Documented",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "⚠️ PREFERRED: Nurtec ODT (rebate-driven); NON-PREFERRED: Ubrelvy",
          "contraBypass": "Yes - CV contraindication",
          "goldCardAvail": "⚠️ Exempt from Act 575",
          "goldCardThresh": null,
          "policyId": "AR PDL",
          "sourceDoc": "Arkansas_2026_PA_Audit",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "CGRP mAbs (SC)": {
          "state": "AR",
          "payerName": "Arkansas Medicaid (FFS/PASSE)",
          "payerType": "Medicaid",
          "lob": "Medicaid",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "≥8 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "PREFERRED: Aimovig, Emgality 120mg, Qulipta, Nurtec preventive; NON-PREFERRED: Ajovy, Vyepti; MOH must be ruled out for Botox",
          "contraBypass": "Yes - teratogenic; cognitive; respiratory",
          "goldCardAvail": "⚠️ Exempt from Act 575",
          "goldCardThresh": null,
          "policyId": "AR PDL",
          "sourceDoc": "Arkansas_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Neurotoxins": {
          "state": "AR",
          "payerName": "Arkansas Medicaid (FFS/PASSE)",
          "payerType": "Medicaid",
          "lob": "Medicaid",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "≥8 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Chronic Migraine dx; must confirm NO medication overuse headache",
          "contraBypass": "Yes - oral contraindications",
          "goldCardAvail": "⚠️ Exempt from Act 575",
          "goldCardThresh": null,
          "policyId": "AR PDL",
          "sourceDoc": "Arkansas_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        }
      },
      "AR-COM-AMBETTER": {
        "CGRP mAbs (SC)": {
          "state": "AR",
          "payerName": "Ambetter Arkansas",
          "payerType": "Commercial",
          "lob": "ACA Exchange",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes (Beta-blocker/TCA/Anticonvulsant)",
          "step1Duration": "Documented",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Aimovig/Emgality = Tier 2/3 Preferred; Qulipta = Step 2; highly litigious on 'medical necessity'",
          "contraBypass": "Yes - teratogenic; cognitive; respiratory",
          "goldCardAvail": "✓ Act 575 applies to J-codes",
          "goldCardThresh": "90%",
          "policyId": "Ambetter Formulary",
          "sourceDoc": "Arkansas_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "AR-PARTB-NOVITAS": {
        "Neurotoxins": {
          "state": "AR",
          "payerName": "Novitas Solutions (AR)",
          "payerType": "Medicare MAC",
          "lob": "Part B",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "Conservative therapy failure",
          "step1Duration": "Documented",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Jurisdiction H; LCD L39909; ⚠️ 'Headache Day' vs 'Migraine Day' math REQUIRED in notes; no state Gold Card (federal)",
          "contraBypass": "Yes - documented oral failures",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "LCD L39909",
          "sourceDoc": "Arkansas_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        },
        "CGRP mAbs (IV)": {
          "state": "AR",
          "payerName": "Novitas Solutions (AR)",
          "payerType": "Medicare MAC",
          "lob": "Part B",
          "drugClass": "CGRP mAbs (IV)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral classes + ≥1 other CGRP mAb",
          "step1Duration": "Documented",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Step 2 agent; TPE audit risk",
          "contraBypass": "Yes - documented failures",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "LCD",
          "sourceDoc": "Arkansas_2026_PA_Audit",
          "denialCode": "DENY-QL-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "MS-COM-BCBSMS": {
        "Gepants (Acute)": {
          "state": "MS",
          "payerName": "Blue Cross Blue Shield Mississippi",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 triptans",
          "step1Duration": "Documented",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Near-monopoly market (~96% ASO); step therapy enforced; focus on clinical precision to trigger automated approval algorithms",
          "contraBypass": "Yes - CV contraindication",
          "goldCardAvail": "⚠️ SB 2140 transparency (not Gold Card)",
          "goldCardThresh": null,
          "policyId": "BCBSMS Formulary",
          "sourceDoc": "Mississippi_2026_PA_Audit",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "CGRP mAbs (SC)": {
          "state": "MS",
          "payerName": "Blue Cross Blue Shield Mississippi",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "≥8 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Third/fourth-line per payer vs first-line per AHS 2024; 'Deemed Authorized' if no response per SB 2140",
          "contraBypass": "Yes - teratogenic; cognitive; respiratory",
          "goldCardAvail": "⚠️ SB 2140 transparency",
          "goldCardThresh": null,
          "policyId": "BCBSMS Formulary",
          "sourceDoc": "Mississippi_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "MS-MCD-MAGNOLIA": {
        "CGRP mAbs (SC)": {
          "state": "MS",
          "payerName": "Magnolia Health Mississippi",
          "payerType": "Medicaid MCO",
          "lob": "Medicaid",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "≥8 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Largest Medicaid MCO; strict step therapy; automated portals; ⚠️ 90-day continuity on UHC exit transition",
          "contraBypass": "Yes - teratogenic; cognitive; respiratory",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "Magnolia Policy",
          "sourceDoc": "Mississippi_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "MS-MCD-MOLINA": {
        "CGRP mAbs (SC)": {
          "state": "MS",
          "payerName": "Molina Healthcare Mississippi",
          "payerType": "Medicaid MCO",
          "lob": "Medicaid",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "≥8 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "High denial rates in initial automated pass; often requires peer-to-peer to overturn step-therapy edits",
          "contraBypass": "Yes - teratogenic; cognitive; respiratory",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "Molina Policy",
          "sourceDoc": "Mississippi_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "MS-MCD-TRUECARE": {
        "CGRP mAbs (SC)": {
          "state": "MS",
          "payerName": "TrueCare Mississippi",
          "payerType": "Medicaid MCO",
          "lob": "Medicaid",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "≥8 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "⚠️ NEW ENTRANT: 'Looser' protocols early 2026; expect UM tightening Q3/Q4 2026; Continuity of Care critical on UHC transition",
          "contraBypass": "Yes - teratogenic; cognitive; respiratory",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "TrueCare Policy",
          "sourceDoc": "Mississippi_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "MS-PARTB-NOVITAS": {
        "Neurotoxins": {
          "state": "MS",
          "payerName": "Novitas Solutions (MS)",
          "payerType": "Medicare MAC",
          "lob": "Part B",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "Conservative therapy failure",
          "step1Duration": "Documented",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Jurisdiction H; LCD L38809; strict 12-week frequency; JW modifier for wastage; TPE audit risk",
          "contraBypass": "Yes - documented oral failures",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "LCD L38809",
          "sourceDoc": "Mississippi_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        }
      },
      "ME-COM-ANTHEM": {
        "Gepants (Acute)": {
          "state": "ME",
          "payerName": "Anthem BCBS Maine",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 triptans",
          "step1Duration": "Documented",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "CarelonRx PBM; 'Select' formulary",
          "contraBypass": "Yes - CV contraindication (Golden Keyword: 'Contraindication to Vasoconstrictive Agents')",
          "goldCardAvail": "⚠️ No mandatory Gold Card",
          "goldCardThresh": null,
          "policyId": "Anthem Formulary",
          "sourceDoc": "Maine_2026_PA_Audit",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "CGRP mAbs (SC)": {
          "state": "ME",
          "payerName": "Anthem BCBS Maine",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2-3 oral preventive classes (Beta-blockers/TCAs/Anticonvulsants)",
          "step1Duration": "≥8 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "24-A MRSA §4304-B: 90-day continuity on plan switch",
          "contraBypass": "Yes - Asthma/COPD (precludes Beta-blockers); Obesity (precludes TCAs); Nephrolithiasis (precludes Topiramate); Teratogenicity (strongest bypass)",
          "goldCardAvail": "⚠️ No mandatory Gold Card",
          "goldCardThresh": null,
          "policyId": "Anthem Formulary",
          "sourceDoc": "Maine_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": "8.0",
          "episodicNotes": "Anthem: Episodic (<8d) = 1 oral class; Episodic (≥8d) = same as chronic (1 oral class). More lenient than most payers for episodic."
        },
        "Gepants (Preventive)": {
          "state": "ME",
          "payerName": "Anthem Maine",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Preventive)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "≥8 weeks",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "16 tabs/30 days (vs 8 for acute)",
          "contraBypass": "Yes - standard",
          "goldCardAvail": "No",
          "goldCardThresh": null,
          "policyId": null,
          "sourceDoc": "Maine_2026_PA_Audit.md",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "Quantity limit distinguishes acute vs preventive"
        }
      },
      "ME-MCD-DHHS": {
        "Gepants (Acute)": {
          "state": "ME",
          "payerName": "MaineCare (DHHS)",
          "payerType": "Medicaid FFS",
          "lob": "Medicaid",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 preferred triptans (Rizatriptan/Sumatriptan)",
          "step1Duration": "Documented",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "⚠️ PREFERRED: Nurtec ODT; NON-PREFERRED: Ubrelvy; Ubrelvy requires Nurtec failure first; QL 8-16 doses/30d (Form #10110 for override)",
          "contraBypass": "Yes - CV contraindication",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "MaineCare PDL",
          "sourceDoc": "Maine_2026_PA_Audit",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "CGRP mAbs (SC)": {
          "state": "ME",
          "payerName": "MaineCare (DHHS)",
          "payerType": "Medicaid FFS",
          "lob": "Medicaid",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "≥8 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "⚠️ PREFERRED: Emgality, Ajovy; NON-PREFERRED: Aimovig; formulary preference diverges from commercial",
          "contraBypass": "Yes - teratogenic; cognitive; respiratory",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "MaineCare PDL",
          "sourceDoc": "Maine_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "ME-COM-CHO": {
        "CGRP mAbs (SC)": {
          "state": "ME",
          "payerName": "Community Health Options (CHO)",
          "payerType": "Commercial",
          "lob": "ACA CO-OP",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "≥8 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Express Scripts PBM; ⚠️ 'Chronic Illness Support Program' (CISP) = bypass for chronic migraine classification",
          "contraBypass": "Yes - teratogenic; cognitive; respiratory",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "CHO Formulary",
          "sourceDoc": "Maine_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "ME-PARTB-NGS": {
        "Neurotoxins": {
          "state": "ME",
          "payerName": "NGS (Maine)",
          "payerType": "Medicare MAC",
          "lob": "Part B",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "Conservative therapy failure",
          "step1Duration": "Documented",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Jurisdiction K; LCD for chronic migraine",
          "contraBypass": "Yes - documented oral failures",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "NGS LCD",
          "sourceDoc": "Maine_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        }
      },
      "VT-COM-BCBSVT": {
        "Gepants (Acute)": {
          "state": "VT",
          "payerName": "Blue Cross Blue Shield Vermont",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 triptans",
          "step1Duration": "Documented",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "⚠️ Vermont Blue Advantage EXITED MA 2026; Act 111 Gold Card applies",
          "contraBypass": "Yes - CV contraindication (Act 111 step therapy exception)",
          "goldCardAvail": "✓ Act 111 Gold Card",
          "goldCardThresh": "90%",
          "policyId": "BCBSVT Formulary",
          "sourceDoc": "Vermont_2026_PA_Audit",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "CGRP mAbs (SC)": {
          "state": "VT",
          "payerName": "Blue Cross Blue Shield Vermont",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "≥8 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Act 111 step therapy exception if 'expected to be ineffective' based on clinical history; 90-day continuity mandate",
          "contraBypass": "Yes - teratogenic (strongest); Asthma/COPD; cognitive",
          "goldCardAvail": "✓ Act 111 Gold Card",
          "goldCardThresh": "90%",
          "policyId": "BCBSVT Formulary",
          "sourceDoc": "Vermont_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Gepants (Preventive)": {
          "state": "VT",
          "payerName": "BCBS VT",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Preventive)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "Standard CGRP criteria (≥2 oral classes)",
          "step1Duration": "≥8 weeks",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "30 tabs/30 days",
          "contraBypass": "Yes - standard bypasses",
          "goldCardAvail": "No",
          "goldCardThresh": null,
          "policyId": null,
          "sourceDoc": "Vermont_2026_PA_Audit.md",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "Preferred oral preventive option"
        }
      },
      "VT-COM-MVP": {
        "CGRP mAbs (SC)": {
          "state": "VT",
          "payerName": "MVP Health Care Vermont",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "≥8 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Distinct CGRP preferences from BCBSVT; Act 111 applies",
          "contraBypass": "Yes - teratogenic; cognitive; respiratory",
          "goldCardAvail": "✓ Act 111 Gold Card",
          "goldCardThresh": "90%",
          "policyId": "MVP Formulary",
          "sourceDoc": "Vermont_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "VT-MCD-DVHA": {
        "CGRP mAbs (SC)": {
          "state": "VT",
          "payerName": "Vermont Medicaid (DVHA)",
          "payerType": "Medicaid FFS",
          "lob": "Medicaid",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "≥8 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Act 111 continuity protections apply to Medicaid plan transitions; state-administered",
          "contraBypass": "Yes - teratogenic; cognitive; respiratory",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "VT PDL",
          "sourceDoc": "Vermont_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "VT-MA-HUMANA": {
        "CGRP mAbs (SC)": {
          "state": "VT",
          "payerName": "Humana Vermont",
          "payerType": "Medicare Advantage",
          "lob": "MA",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "Documented",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "⚠️ One of few remaining MA plans after VT Blue Advantage + UHC exits; ~50K beneficiaries migrating",
          "contraBypass": "Yes - teratogenic; cognitive; respiratory",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "Humana Formulary",
          "sourceDoc": "Vermont_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        }
      },
      "VT-PARTB-NGS": {
        "Neurotoxins": {
          "state": "VT",
          "payerName": "NGS (Vermont)",
          "payerType": "Medicare MAC",
          "lob": "Part B",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "Same as VT-MAC-NGS — updated Botox LCD effective February 22, 2026",
          "step1Duration": "Same as VT-MAC-NGS — updated Botox LCD effective February 22, 2026",
          "step2Req": "LCD L35172 explicitly requires documentation supporting trials of an inadequate response to at least one agent in two different classes of oral medications; introduces a mandatory requirement for documentation regarding CGRP therapy.",
          "step2Duration": null,
          "quantityLimit": "Jurisdiction K; ⚠️ ~50K beneficiaries now back to Original Medicare after MA exits; LCD governs Part B",
          "contraBypass": "Yes - documented oral failures",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "NGS LCD",
          "sourceDoc": "Q1-2026-Policy-Refresh",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "LCD L35172 explicitly requires documentation supporting trials of an inadequate response to at least one agent in two different classes of oral medications; introduces a mandatory requirement for documentation regarding CGRP therapy."
        }
      },
      "NH-COM-HARVARDPILGRIM": {
        "Gepants (Acute)": {
          "state": "NH",
          "payerName": "Harvard Pilgrim NH",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥1 triptan ('Smart PA' checks claims history for triptan fill in 180 days)",
          "step1Duration": "Claims history or documented samples",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Tier 3/4; 'Smart PA' logic - auto-approve if triptan claims exist; must manually document samples if no claims history",
          "contraBypass": "Yes - CV contraindication",
          "goldCardAvail": "⚠️ SB 561 applies",
          "goldCardThresh": "2 biz days",
          "policyId": "HPHC MNG",
          "sourceDoc": "New_Hampshire_2026_PA_Audit",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "CGRP mAbs (SC)": {
          "state": "NH",
          "payerName": "Harvard Pilgrim NH",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥1-2 oral preventive classes",
          "step1Duration": "Documented",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "⚠️ 'AJOVY CLIFF' - Ajovy NON-FORMULARY Jan 2026; must submit Formulary Exception using MOA argument (ligand vs receptor) or adverse event history; PREFERRED: Aimovig/Emgality",
          "contraBypass": "Yes - ligand vs receptor MOA argument for Ajovy exception; prior adverse events to preferred agents",
          "goldCardAvail": "⚠️ SB 561 applies",
          "goldCardThresh": "2 biz days",
          "policyId": "HPHC MNG",
          "sourceDoc": "New_Hampshire_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Neurotoxins": {
          "state": "NH",
          "payerName": "Harvard Pilgrim NH",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "Documented",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Chronic Migraine dx (≥15 HA days/mo, ≥8 migraine days); 155 units/12 weeks",
          "contraBypass": "Yes - documented oral failures",
          "goldCardAvail": "⚠️ SB 561 applies",
          "goldCardThresh": "2 biz days",
          "policyId": "HPHC MNG",
          "sourceDoc": "New_Hampshire_2026_Prior_Authorization_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        }
      },
      "NH-MCD-HEALTHYFAMILIES": {
        "Gepants (Acute)": {
          "state": "NH",
          "payerName": "NH Healthy Families",
          "payerType": "Medicaid MCO",
          "lob": "Medicaid",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 preferred triptans",
          "step1Duration": "Documented",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "⚠️ Triptan QL: 9 tabs/30d; MOH Risk argument for gepant access when >9 days/month acute treatment needed",
          "contraBypass": "Yes - CV contraindication; MOH risk",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "NH PDL",
          "sourceDoc": "New_Hampshire_2026_PA_Audit",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "CGRP mAbs (SC)": {
          "state": "NH",
          "payerName": "NH Healthy Families",
          "payerType": "Medicaid MCO",
          "lob": "Medicaid",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "⚠️ ≥2 different oral preventive classes",
          "step1Duration": "⚠️ ≥8 weeks EACH (potential 16-month delay)",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "PREFERRED: Aimovig, Emgality; NON-PREFERRED: Ajovy, Vyepti (requires failure of BOTH preferred or contraindication); Adverse Event stops 8-week clock immediately",
          "contraBypass": "Yes - teratogenic; cognitive (stops 8-week clock); latex allergy (autoinjectors); needle phobia (Vyepti)",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "NH PDL",
          "sourceDoc": "New_Hampshire_2026_PA_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Gepants (Preventive)": {
          "state": "NH",
          "payerName": "NH Healthy Families",
          "payerType": "Medicaid FFS",
          "lob": "Medicaid",
          "drugClass": "Gepants (Preventive)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "Per national Medicaid trends",
          "step1Duration": "≥8 weeks",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "30 tabs/30 days",
          "contraBypass": "Yes - standard",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": null,
          "sourceDoc": "NATIONAL_BASELINE",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "NATIONAL BASELINE - no state audit document"
        },
        "Neurotoxins": {
          "state": "NH",
          "payerName": "NH Healthy Families",
          "payerType": "Medicaid MCO",
          "lob": "Medicaid",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes (strict PDL)",
          "step1Duration": "≥8 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Chronic Migraine dx (≥15 HA days/mo, ≥8 migraine days); 155 units/12 weeks; Centene MCO approval",
          "contraBypass": "Yes - documented oral failures",
          "goldCardAvail": "N/A - Medicaid",
          "goldCardThresh": null,
          "policyId": "NH PDL",
          "sourceDoc": "New_Hampshire_2026_Prior_Authorization_Audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. Episodic (4-14 days/month) = automatic denial. ICD-10 must be G43.7xx series."
        }
      },
      "NH-PARTB-NGS": {
        "Neurotoxins": {
          "state": "NH",
          "payerName": "NGS (New Hampshire)",
          "payerType": "Medicare MAC",
          "lob": "Part B",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "Conservative therapy failure",
          "step1Duration": "Documented",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Jurisdiction K; LCD for chronic migraine; ⚠️ $2,100 Part D Cap means oral CGRPs now more viable for seniors (hit cap by March/April, then $0 rest of year)",
          "contraBypass": "Yes - documented oral failures",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "NGS LCD",
          "sourceDoc": "Q1-2026-Policy-Refresh",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "Continuation strictly requires demonstration of significant decrease in headache number/frequency"
        }
      },
      "ALL-PARTB-CLUSTER": {
        "CGRP mAbs (Cluster)": {
          "state": "ALL",
          "payerName": "Medicare Part B (All MACs)",
          "payerType": "Medicare MAC",
          "lob": "Part B",
          "drugClass": "CGRP mAbs (Cluster)",
          "medCategory": "Cluster Headache Prevention",
          "stepTherapyRequired": "Yes",
          "step1Req": "Failed conventional cluster prevention (verapamil, lithium, topiramate)",
          "step1Duration": "Documented in medical record",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Emgality 300mg monthly; ⛔ EPISODIC CLUSTER ONLY per FDA; ICD-10 must be G44.011 or G44.019",
          "contraBypass": "Yes - documented intolerance to verapamil or lithium",
          "goldCardAvail": "No - Federal Medicare",
          "goldCardThresh": null,
          "policyId": "LCD varies by MAC",
          "sourceDoc": "Medicare Cluster Headache Coverage Policy",
          "denialCode": "DENY-CLUSTER-001",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ CLUSTER HEADACHE - DISTINCT FROM MIGRAINE. Emgality 300mg is ONLY FDA-approved CGRP. Episodic cluster only (G44.01x)."
        }
      },
      "MA-COM-BCBSMA-CLUSTER": {
        "CGRP mAbs (Cluster)": {
          "state": "MA",
          "payerName": "Blue Cross Blue Shield Massachusetts",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (Cluster)",
          "medCategory": "Cluster Headache Prevention",
          "stepTherapyRequired": "Yes",
          "step1Req": "Failure of verapamil, lithium, OR topiramate",
          "step1Duration": "Documented trial",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Emgality 300mg monthly; ≥5 cluster attacks per month required",
          "contraBypass": "Yes - cardiac or renal/thyroid contraindications",
          "goldCardAvail": "N/A for cluster",
          "goldCardThresh": null,
          "policyId": "BCBSMA Cluster Policy",
          "sourceDoc": "Massachusetts_2026_PA_Audit",
          "denialCode": "DENY-CLUSTER-001",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "BCBSMA cluster: Emgality 300mg for episodic cluster requires verapamil/lithium/topiramate failure."
        }
      },
      "NJ-COM-AETNA-CLUSTER": {
        "CGRP mAbs (Cluster)": {
          "state": "NJ",
          "payerName": "Aetna",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (Cluster)",
          "medCategory": "Cluster Headache Prevention",
          "stepTherapyRequired": "Yes",
          "step1Req": "Failure of verapamil OR lithium",
          "step1Duration": "Documented trial",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Emgality 300mg monthly; ⚠️ Use cluster PA form NOT migraine form",
          "contraBypass": "Yes - documented intolerance",
          "goldCardAvail": "N/A for cluster",
          "goldCardThresh": null,
          "policyId": "Aetna Cluster Policy",
          "sourceDoc": "New_Jersey_2026_PA_Audit",
          "denialCode": "DENY-CLUSTER-001",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⚠️ Aetna cluster criteria DISTINCT from migraine. Using migraine PA form = automatic denial."
        }
      },
      "OK-COM-BCBSOK-CLUSTER": {
        "CGRP mAbs (Cluster)": {
          "state": "OK",
          "payerName": "Blue Cross Blue Shield Oklahoma",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (Cluster)",
          "medCategory": "Cluster Headache Prevention",
          "stepTherapyRequired": "Yes",
          "step1Req": "Failure of verapamil, lithium, OR topiramate",
          "step1Duration": "Documented trial",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Emgality 300mg monthly; Episodic cluster only",
          "contraBypass": "Yes - documented contraindications",
          "goldCardAvail": "HB 1808 transparency applies",
          "goldCardThresh": null,
          "policyId": "BCBSOK Cluster Policy",
          "sourceDoc": "Oklahoma_2026_PA_Audit",
          "denialCode": "DENY-CLUSTER-001",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "BCBSOK cluster: Emgality 100mg is the only indicated CGRP. Step therapy: verapamil, lithium, or topiramate."
        }
      },
      "ALL-COM-UHC-CLUSTER": {
        "CGRP mAbs (Cluster)": {
          "state": "ALL",
          "payerName": "UnitedHealthcare (National)",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (Cluster)",
          "medCategory": "Cluster Headache Prevention",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥1 conventional cluster preventive (verapamil preferred, lithium, topiramate)",
          "step1Duration": "Adequate trial documented",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Emgality 300mg monthly; Episodic cluster diagnosis required (G44.01x)",
          "contraBypass": "Yes - cardiac/renal/thyroid contraindications",
          "goldCardAvail": "Yes (National Gold Card)",
          "goldCardThresh": "≥92% approval x 2 years",
          "policyId": "UHC Cluster Policy",
          "sourceDoc": "UHC_National_Guidelines",
          "denialCode": "DENY-CLUSTER-001",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "UHC cluster: Requires episodic diagnosis and failure of at least one conventional preventive."
        }
      },
      "ALL-COM-CIGNA-CLUSTER": {
        "CGRP mAbs (Cluster)": {
          "state": "ALL",
          "payerName": "Cigna (National)",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (Cluster)",
          "medCategory": "Cluster Headache Prevention",
          "stepTherapyRequired": "Yes",
          "step1Req": "Documented trial of verapamil AND/OR lithium at therapeutic doses",
          "step1Duration": "≥2 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Emgality 300mg monthly; ⚠️ Cluster criteria separate from migraine",
          "contraBypass": "Yes - document ECG abnormalities for verapamil; renal function for lithium",
          "goldCardAvail": "Yes (National Gold Card)",
          "goldCardThresh": "Voluntary program",
          "policyId": "Cigna Cluster Policy",
          "sourceDoc": "Cigna_National_Guidelines",
          "denialCode": "DENY-CLUSTER-001",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "Cigna cluster: Requires verapamil and/or lithium failure. ECG documentation important."
        }
      },
      "ALL-COM-AETNA": {
        "CGRP mAbs (SC)": {
          "state": "ALL",
          "payerName": "Aetna (National)",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥1 oral preventive class (Beta-blocker OR Anticonvulsant OR Antidepressant)",
          "step1Duration": "≥3 months each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "4 syringes/28 days",
          "contraBypass": "Yes - CV disease; Teratogenicity; Cognitive impairment",
          "goldCardAvail": "No",
          "goldCardThresh": null,
          "policyId": "CPB 0970",
          "sourceDoc": "National_Aetna_CPB_2026",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Gepants (Acute)": {
          "state": "ALL",
          "payerName": "Aetna (National)",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 triptans (failure/contraindication/intolerance)",
          "step1Duration": "≥30 days each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "16 tablets/30 days",
          "contraBypass": "Yes - CV disease; Hemiplegic migraine",
          "goldCardAvail": "No",
          "goldCardThresh": null,
          "policyId": "CGRP Oral Policy 3481-E",
          "sourceDoc": "National_Aetna_CPB_2026",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Neurotoxins": {
          "state": "ALL",
          "payerName": "Aetna (National)",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes (Anticonvulsant + one other)",
          "step1Duration": "≥8 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "155 units/12 weeks",
          "contraBypass": "Yes - Teratogenicity; Severe AE",
          "goldCardAvail": "No",
          "goldCardThresh": null,
          "policyId": "CPB 0113",
          "sourceDoc": "National_Aetna_CPB_2026",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ Chronic Migraine only (≥15 days/mo for ≥3 months with ≥8 migrainous days). Aetna requires ≥4 hrs/day documentation."
        }
      },
      "ALL-COM-CIGNA": {
        "CGRP mAbs (SC)": {
          "state": "ALL",
          "payerName": "Cigna (National)",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes (from: Beta-blockers, Anticonvulsants, Antidepressants)",
          "step1Duration": "≥8 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "4 syringes/28 days",
          "contraBypass": "Yes - CV disease; Teratogenicity; Cognitive impairment",
          "goldCardAvail": "No",
          "goldCardThresh": null,
          "policyId": "IP0377",
          "sourceDoc": "National_Cigna_Policy_2026",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": "8.0",
          "episodicNotes": "Cigna has tiered policy: High-freq episodic (≥8 days/mo) may have expedited access"
        },
        "Gepants (Acute)": {
          "state": "ALL",
          "payerName": "Cigna (National)",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 triptans (Step 1: Sumatriptan/Rizatriptan)",
          "step1Duration": "≥30 days each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "16 tablets/30 days",
          "contraBypass": "Yes - CV disease; Hemiplegic migraine",
          "goldCardAvail": "No",
          "goldCardThresh": null,
          "policyId": "Migraine Step Therapy Policy",
          "sourceDoc": "National_Cigna_Policy_2026",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Neurotoxins": {
          "state": "ALL",
          "payerName": "Cigna (National)",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "≥8 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "155 units/12 weeks",
          "contraBypass": "Yes - Teratogenicity; Severe AE",
          "goldCardAvail": "No",
          "goldCardThresh": null,
          "policyId": "IP0637",
          "sourceDoc": "National_Cigna_Policy_2026",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ Chronic Migraine only (≥15 days/mo). Renewal requires documented reduction in headache days."
        }
      },
      "ALL-COM-ANTHEM": {
        "CGRP mAbs (SC)": {
          "state": "ALL",
          "payerName": "Anthem/Elevance (National)",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥1 oral preventive class (Beta-blocker OR Anticonvulsant OR Antidepressant)",
          "step1Duration": "≥2 months",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "4 syringes/28 days",
          "contraBypass": "Yes - CV disease; Teratogenicity",
          "goldCardAvail": "No",
          "goldCardThresh": null,
          "policyId": "ING-CC-0032",
          "sourceDoc": "National_Anthem_Policy_2026",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "Anthem more lenient: requires only 1 oral failure. Prefers Emgality/Ajovy over Aimovig."
        },
        "Gepants (Acute)": {
          "state": "ALL",
          "payerName": "Anthem/Elevance (National)",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 generic triptans",
          "step1Duration": "≥30 days each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "16 tablets/30 days",
          "contraBypass": "Yes - CV disease; Uncontrolled HTN",
          "goldCardAvail": "No",
          "goldCardThresh": null,
          "policyId": "Antimigraine Policy",
          "sourceDoc": "National_Anthem_Policy_2026",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Neurotoxins": {
          "state": "ALL",
          "payerName": "Anthem/Elevance (National)",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes (must include anticonvulsant: Topiramate/Divalproex)",
          "step1Duration": "≥8 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "155 units/12 weeks",
          "contraBypass": "Yes - Teratogenicity bypasses anticonvulsant requirement",
          "goldCardAvail": "No",
          "goldCardThresh": null,
          "policyId": "ING-CC-0032",
          "sourceDoc": "National_Anthem_Policy_2026",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ Chronic Migraine only. Combination ban: Botox+CGRP requires refractory documentation."
        }
      },
      "ALL-COM-HUMANA": {
        "CGRP mAbs (SC)": {
          "state": "ALL",
          "payerName": "Humana (National)",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes (from: Beta-blockers, Anticonvulsants, Antidepressants)",
          "step1Duration": "≥8 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "4 syringes/28 days",
          "contraBypass": "Yes - CV disease; Teratogenicity",
          "goldCardAvail": "Yes",
          "goldCardThresh": "Provider Gold Card program (voluntary)",
          "policyId": null,
          "sourceDoc": "National_Humana_Policy_2026",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Gepants (Acute)": {
          "state": "ALL",
          "payerName": "Humana (National)",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 triptans (failure/contraindication/intolerance)",
          "step1Duration": "≥30 days each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "16 tablets/30 days",
          "contraBypass": "Yes - CV disease",
          "goldCardAvail": "Yes",
          "goldCardThresh": "Provider Gold Card program (voluntary)",
          "policyId": null,
          "sourceDoc": "National_Humana_Policy_2026",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Neurotoxins": {
          "state": "ALL",
          "payerName": "Humana (National)",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "≥8 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "155 units/12 weeks",
          "contraBypass": "Yes - Teratogenicity; Severe AE",
          "goldCardAvail": "Yes",
          "goldCardThresh": "Provider Gold Card program (voluntary)",
          "policyId": null,
          "sourceDoc": "National_Humana_Policy_2026",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ Chronic Migraine only (≥15 days/mo)."
        }
      },
      "ALL-COM-KAISER": {
        "CGRP mAbs (SC)": {
          "state": "ALL",
          "payerName": "Kaiser Permanente (National)",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥3 oral preventive classes: Beta-blocker (Propranolol/Atenolol) + TCA (Amitriptyline/Nortriptyline) + Anticonvulsant (Topiramate/Divalproex)",
          "step1Duration": "≥6-8 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "4 syringes/28 days",
          "contraBypass": "Yes - CV disease; Teratogenicity; Cognitive impairment",
          "goldCardAvail": "No",
          "goldCardThresh": null,
          "policyId": "Kaiser Formulary 2026",
          "sourceDoc": "National_Kaiser_Policy_2026",
          "denialCode": "DENY-STEP-003",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⚠️ Most restrictive: \"Step 3\" firewall requires 3 class failures. CGRPs are Tier 4/Non-Preferred."
        },
        "Gepants (Acute)": {
          "state": "ALL",
          "payerName": "Kaiser Permanente (National)",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 triptans (failure/contraindication/intolerance)",
          "step1Duration": "≥30 days each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "16 tablets/30 days",
          "contraBypass": "Yes - CV disease",
          "goldCardAvail": "No",
          "goldCardThresh": null,
          "policyId": "Kaiser Formulary 2026",
          "sourceDoc": "National_Kaiser_Policy_2026",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Neurotoxins": {
          "state": "ALL",
          "payerName": "Kaiser Permanente (National)",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "≥8 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "155 units/12 weeks",
          "contraBypass": "Yes - Teratogenicity; Severe AE",
          "goldCardAvail": "No",
          "goldCardThresh": null,
          "policyId": "Kaiser Formulary 2026",
          "sourceDoc": "National_Kaiser_Policy_2026",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ Chronic Migraine only (≥15 days/mo). Concurrent CGRP+Botox prohibited without explicit refractory documentation."
        }
      },
      "ALL-COM-MOLINA": {
        "CGRP mAbs (SC)": {
          "state": "ALL",
          "payerName": "Molina Healthcare (National)",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes (from: Beta-blockers, Anticonvulsants, Antidepressants)",
          "step1Duration": "≥8 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "4 syringes/28 days",
          "contraBypass": "Yes - CV disease; Teratogenicity",
          "goldCardAvail": "No",
          "goldCardThresh": null,
          "policyId": "Molina Medical Policy 2026",
          "sourceDoc": "National_Molina_Policy_2026",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Gepants (Acute)": {
          "state": "ALL",
          "payerName": "Molina Healthcare (National)",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 triptans (failure/contraindication/intolerance)",
          "step1Duration": "≥30 days each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "8 tablets/30 days",
          "contraBypass": "Yes - CV disease",
          "goldCardAvail": "No",
          "goldCardThresh": null,
          "policyId": "Molina Medical Policy 2026",
          "sourceDoc": "National_Molina_Policy_2026",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⚠️ Molina may have stricter quantity limits (8 vs 16 tablets)"
        },
        "Neurotoxins": {
          "state": "ALL",
          "payerName": "Molina Healthcare (National)",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "≥8 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "155 units/12 weeks",
          "contraBypass": "Yes - Teratogenicity; Severe AE",
          "goldCardAvail": "No",
          "goldCardThresh": null,
          "policyId": "Molina Medical Policy 2026",
          "sourceDoc": "National_Molina_Policy_2026",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ Chronic Migraine only (≥15 days/mo)."
        }
      },
      "ALL-COM-CENTENE": {
        "CGRP mAbs (SC)": {
          "state": "ALL",
          "payerName": "Centene/Ambetter (National)",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes (from: Beta-blockers, Anticonvulsants, Antidepressants)",
          "step1Duration": "≥8 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "4 syringes/28 days",
          "contraBypass": "Yes - CV disease; Teratogenicity",
          "goldCardAvail": "No",
          "goldCardThresh": null,
          "policyId": "Centene Medical Policy 2026",
          "sourceDoc": "National_Centene_Policy_2026",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Gepants (Acute)": {
          "state": "ALL",
          "payerName": "Centene/Ambetter (National)",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 triptans (failure/contraindication/intolerance)",
          "step1Duration": "≥30 days each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "16 tablets/30 days",
          "contraBypass": "Yes - CV disease",
          "goldCardAvail": "No",
          "goldCardThresh": null,
          "policyId": "Centene Medical Policy 2026",
          "sourceDoc": "National_Centene_Policy_2026",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": null
        },
        "Neurotoxins": {
          "state": "ALL",
          "payerName": "Centene/Ambetter (National)",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "≥8 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "155 units/12 weeks",
          "contraBypass": "Yes - Teratogenicity; Severe AE",
          "goldCardAvail": "No",
          "goldCardThresh": null,
          "policyId": "Centene Medical Policy 2026",
          "sourceDoc": "National_Centene_Policy_2026",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ Chronic Migraine only (≥15 days/mo)."
        }
      },
      "AL-MCD-ALMED": {
        "Gepants (Preventive)": {
          "state": "AL",
          "payerName": "Alabama Medicaid",
          "payerType": "Medicaid FFS",
          "lob": "Medicaid",
          "drugClass": "Gepants (Preventive)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "Standard CGRP criteria with CC",
          "step1Duration": "≥8 weeks",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "30 tabs/30 days",
          "contraBypass": "Yes - standard",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": null,
          "sourceDoc": "Alabama_2026_PA_Audit.docx",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "Listed as Preferred with Clinical Criteria"
        }
      },
      "CA-MCD-MEDICAL": {
        "Gepants (Preventive)": {
          "state": "CA",
          "payerName": "Medi-Cal",
          "payerType": "Medicaid FFS",
          "lob": "Medicaid",
          "drugClass": "Gepants (Preventive)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "Fail CGRPs (Aimovig/Emgality) + standard criteria",
          "step1Duration": "≥8 weeks",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "16 tabs/30 days",
          "contraBypass": "Unknown",
          "goldCardAvail": "No",
          "goldCardThresh": null,
          "policyId": null,
          "sourceDoc": "California_2026_PA_Audit.docx",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "Requires CGRP mAb failure for preventive use"
        }
      },
      "CO-COM-VARIOUS": {
        "Gepants (Preventive)": {
          "state": "CO",
          "payerName": "Multiple",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Preventive)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "Standard CGRP criteria",
          "step1Duration": "≥8 weeks",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "30 tabs/30 days",
          "contraBypass": "Yes - standard",
          "goldCardAvail": "No",
          "goldCardThresh": null,
          "policyId": null,
          "sourceDoc": "Colorado_2026_PA_Audit.docx",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "Medicare Part D: $2000 cap eliminates donut hole"
        }
      },
      "DE-MCD-DELAWARE1ST": {
        "Gepants (Preventive)": {
          "state": "DE",
          "payerName": "Delaware First Health (Centene)",
          "payerType": "Medicaid MCO",
          "lob": "Medicaid",
          "drugClass": "Gepants (Preventive)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "Fail oral preventives",
          "step1Duration": "≥6 weeks",
          "step2Req": "Fail preferred CGRP mAb",
          "step2Duration": null,
          "quantityLimit": "30 tabs/30 days",
          "contraBypass": "90-day transition fill for plan switches",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "CP.PHAR.230",
          "sourceDoc": "Delaware_2026_PA_Audit.docx",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "Step 3 agent - requires oral AND mAb failure"
        }
      },
      "FL-COM-FLBLUE": {
        "Gepants (Preventive)": {
          "state": "FL",
          "payerName": "Florida Blue",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Preventive)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "Fail injectable CGRP first",
          "step1Duration": "≥8 weeks",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "30 tabs/30 days",
          "contraBypass": "Yes - standard",
          "goldCardAvail": "No",
          "goldCardThresh": null,
          "policyId": null,
          "sourceDoc": "Florida_2026_PA_Audit.docx",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "Usually requires step through injectable CGRP first"
        }
      },
      "FL-COM-VARIOUS": {
        "Gepants (Preventive)": {
          "state": "FL",
          "payerName": "Multiple",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Preventive)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "Standard CGRP criteria",
          "step1Duration": "≥8 weeks",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "30 tabs/30 days",
          "contraBypass": "Yes - Topamax bypass for CGRP",
          "goldCardAvail": "No",
          "goldCardThresh": null,
          "policyId": null,
          "sourceDoc": "Florida_2026_PA_Audit.docx",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "First-line defense argument applies"
        }
      },
      "MN-COM-HEALTHPART": {
        "Gepants (Preventive)": {
          "state": "MN",
          "payerName": "HealthPartners",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Preventive)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "≥8 weeks",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "16 tabs/30 days",
          "contraBypass": "Yes - standard",
          "goldCardAvail": "No",
          "goldCardThresh": null,
          "policyId": null,
          "sourceDoc": "Minnesota_2026_PA_Audit.docx",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "Only approved for EPISODIC migraine prevention"
        }
      },
      "MN-COM-BCBSMN": {
        "Gepants (Preventive)": {
          "state": "MN",
          "payerName": "BCBS Minnesota",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Preventive)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "Oral preventive history",
          "step1Duration": "≥8 weeks",
          "step2Req": "Injectable CGRP in some plans",
          "step2Duration": null,
          "quantityLimit": "30 tabs/30 days",
          "contraBypass": "No dual therapy with Botox without documentation",
          "goldCardAvail": "No",
          "goldCardThresh": null,
          "policyId": null,
          "sourceDoc": "Minnesota_2026_PA_Audit.docx",
          "denialCode": "DENY-DUAL-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "Tier 4/5 placement; dual therapy restrictions"
        }
      },
      "NV-COM-AETNA": {
        "Gepants (Preventive)": {
          "state": "NV",
          "payerName": "Aetna",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Preventive)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "Fail 2 oral classes",
          "step1Duration": "≥6 weeks each",
          "step2Req": "Fail 1 injectable CGRP",
          "step2Duration": null,
          "quantityLimit": "30 tabs/30 days",
          "contraBypass": "Yes - needle phobia valid bypass",
          "goldCardAvail": "No",
          "goldCardThresh": null,
          "policyId": null,
          "sourceDoc": "Nevada_2026_PA_Audit_Report.docx",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "Double step - common bottleneck"
        }
      },
      "NV-COM-VARIOUS": {
        "Gepants (Preventive)": {
          "state": "NV",
          "payerName": "Multiple",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Preventive)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "Standard CGRP criteria",
          "step1Duration": "≥8 weeks",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "30 tabs/30 days",
          "contraBypass": "Yes - needle phobia; arthritis; tremor",
          "goldCardAvail": "No",
          "goldCardThresh": null,
          "policyId": null,
          "sourceDoc": "Nevada_2026_PA_Audit_Report.docx",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "Part D covers oral preventive"
        }
      },
      "NY-COM-EMPIRE": {
        "Gepants (Preventive)": {
          "state": "NY",
          "payerName": "Empire BCBS",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Preventive)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "Standard CGRP criteria (less restrictive than injectable)",
          "step1Duration": "≥8 weeks",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "16 tabs/30 days",
          "contraBypass": "Yes - standard",
          "goldCardAvail": "No",
          "goldCardThresh": null,
          "policyId": null,
          "sourceDoc": "New_York_2026_PA_Audit.docx",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "Preferred for preventive use - Empire is oral-forward"
        }
      },
      "OH-MCD-UPDL": {
        "Gepants (Preventive)": {
          "state": "OH",
          "payerName": "Ohio UPDL",
          "payerType": "Medicaid FFS",
          "lob": "Medicaid",
          "drugClass": "Gepants (Preventive)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "Fail oral generics AND preferred injectable CGRP",
          "step1Duration": "≥8 weeks",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "30 tabs/30 days",
          "contraBypass": "None documented",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": null,
          "sourceDoc": "Ohio_2026_PA_Audit_Strategy.docx",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "Non-Preferred with strict Step Therapy"
        }
      },
      "OH-COM-ANTHEM": {
        "Gepants (Preventive)": {
          "state": "OH",
          "payerName": "Anthem Ohio",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Preventive)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "Fail preferred injectable CGRP (Emgality/Aimovig)",
          "step1Duration": "≥8 weeks",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "30 tabs/30 days",
          "contraBypass": "Yes - needle phobia (F40.231); inability to self-inject",
          "goldCardAvail": "No",
          "goldCardThresh": null,
          "policyId": null,
          "sourceDoc": "Ohio_2026_PA_Audit_Strategy.docx",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "Double step - requires injectable CGRP step"
        }
      },
      "PA-MCD-PADHS": {
        "Gepants (Preventive)": {
          "state": "PA",
          "payerName": "PA DHS Medicaid",
          "payerType": "Medicaid FFS",
          "lob": "Medicaid",
          "drugClass": "Gepants (Preventive)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "PA DHS Statewide PDL requirements",
          "step1Duration": "≥8 weeks",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "30 tabs/30 days",
          "contraBypass": "Stability exception available",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": null,
          "sourceDoc": "Pennsylvania_2026_PA_Audit.docx",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "Pharmacy carved out to FFS PDL for MCOs"
        }
      },
      "SD-PARTD-VARIOUS": {
        "Gepants (Preventive)": {
          "state": "SD",
          "payerName": "Medicare Part D",
          "payerType": "Medicare",
          "lob": "Part D",
          "drugClass": "Gepants (Preventive)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "Per formulary tier",
          "step1Duration": null,
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "16 tabs/30 days",
          "contraBypass": null,
          "goldCardAvail": "No",
          "goldCardThresh": null,
          "policyId": null,
          "sourceDoc": "South_Dakota_2026_PA_Audit.docx",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "Avoid unless Aimovig/Ajovy/Emgality contraindicated"
        }
      },
      "TX-ACA-AMBETTER": {
        "Gepants (Preventive)": {
          "state": "TX",
          "payerName": "Ambetter",
          "payerType": "Marketplace",
          "lob": "ACA",
          "drugClass": "Gepants (Preventive)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "Formulary Exception required",
          "step1Duration": "≥8 weeks",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "30 tabs/30 days",
          "contraBypass": "Yes - standard",
          "goldCardAvail": "No",
          "goldCardThresh": null,
          "policyId": null,
          "sourceDoc": "Texas_2026_PA_Audit.docx",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "Non-Preferred - frequently restricted"
        }
      },
      "UT-MCD-HEALTHYU": {
        "Gepants (Preventive)": {
          "state": "UT",
          "payerName": "Healthy U (Medicaid)",
          "payerType": "Medicaid MCO",
          "lob": "Medicaid",
          "drugClass": "Gepants (Preventive)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "Fail Ajovy AND Emgality AND Aimovig OR documented disability/phobia",
          "step1Duration": "≥8 weeks",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "30 tabs/30 days",
          "contraBypass": "Yes - needle phobia with vasovagal response; documented injection disability",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "pharm-hu-016",
          "sourceDoc": "Utah_2026_PA_Audit.docx",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "LAST-LINE - must fail ALL 3 mAbs or have documented phobia"
        }
      },
      "UT-COM-SELECT": {
        "Gepants (Preventive)": {
          "state": "UT",
          "payerName": "SelectHealth",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Preventive)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "Fail oral generics AND injectable CGRP mAbs",
          "step1Duration": "≥8 weeks",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "16 tabs/30 days",
          "contraBypass": "Yes - needle phobia",
          "goldCardAvail": "No",
          "goldCardThresh": null,
          "policyId": null,
          "sourceDoc": "Utah_2026_PA_Audit.docx",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "Step 3 positioning - same as Qulipta"
        }
      },
      "WA-COM-PREMERA": {
        "Gepants (Preventive)": {
          "state": "WA",
          "payerName": "Premera",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Preventive)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "Fail injectables first",
          "step1Duration": "≥8 weeks",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "16 tabs/30 days",
          "contraBypass": "Yes - standard",
          "goldCardAvail": "No",
          "goldCardThresh": null,
          "policyId": null,
          "sourceDoc": "Washington_State_PA_Audit.docx",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "Non-preferred - requires injectable failure"
        }
      },
      "WA-COM-PREMERA-PED": {
        "Gepants (Preventive)": {
          "state": "WA",
          "payerName": "Premera",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Preventive)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "Fail 2 pediatric-appropriate preventives",
          "step1Duration": "≥8 weeks",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "30 tabs/30 days",
          "contraBypass": "Yes - pediatric pathway available",
          "goldCardAvail": "No",
          "goldCardThresh": null,
          "policyId": null,
          "sourceDoc": "Washington_State_PA_Audit_2026.docx",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "PEDIATRIC (6-17): Specific criteria for Qulipta - formal pathway"
        }
      },
      "AR-MCD-ARMEDIC": {
        "Gepants (Preventive)": {
          "state": "AR",
          "payerName": "Arkansas Medicaid",
          "payerType": "Medicaid FFS",
          "lob": "Medicaid",
          "drugClass": "Gepants (Preventive)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "≥8 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "16 tabs/30 days",
          "contraBypass": "Yes - standard",
          "goldCardAvail": "No",
          "goldCardThresh": null,
          "policyId": null,
          "sourceDoc": "Arkansas_2026_PA_Audit.md",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "Preferred with preventive dosing"
        }
      },
      "CT-ACA-EXCHANGE": {
        "Gepants (Preventive)": {
          "state": "CT",
          "payerName": "CT Exchange Plans",
          "payerType": "Marketplace",
          "lob": "ACA",
          "drugClass": "Gepants (Preventive)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥1 oral preventive class",
          "step1Duration": "≥8 weeks",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "30 tabs/30 days",
          "contraBypass": "Yes - intolerance to oral preventives",
          "goldCardAvail": "No",
          "goldCardThresh": null,
          "policyId": null,
          "sourceDoc": "Connecticut_2026_PA_Audit.md",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "Preferred status - less restrictive"
        }
      },
      "NC-COM-BCBSNC": {
        "Gepants (Preventive)": {
          "state": "NC",
          "payerName": "BCBS NC",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Preventive)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "Fail 2 oral prophylactic classes",
          "step1Duration": "≥8 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "16 tabs/30 days",
          "contraBypass": "Yes - standard",
          "goldCardAvail": "No",
          "goldCardThresh": null,
          "policyId": null,
          "sourceDoc": "North_Carolina_2026_PA_Audit.md",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "Preferred status with preventive dosing; same QL for acute/preventive"
        }
      },
      "ND-MCD-NDMEDIC": {
        "Gepants (Preventive)": {
          "state": "ND",
          "payerName": "ND Medicaid",
          "payerType": "Medicaid FFS",
          "lob": "Medicaid",
          "drugClass": "Gepants (Preventive)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "≥2 months each",
          "step2Req": "Fail ALL 3 CGRP mAbs (Ajovy/Emgality/Aimovig)",
          "step2Duration": "≥3 months each",
          "quantityLimit": "30 tabs/30 days",
          "contraBypass": "None documented",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": null,
          "sourceDoc": "North_Dakota_2026_PA_Audit.md",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "MOST RESTRICTIVE - effectively Step 4"
        }
      },
      "WI-COM-QUARTZ": {
        "Gepants (Preventive)": {
          "state": "WI",
          "payerName": "GHC/Quartz",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Preventive)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral classes",
          "step1Duration": "≥8 weeks",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "16 tabs/30 days",
          "contraBypass": "Yes - history of triptan use",
          "goldCardAvail": "No",
          "goldCardThresh": null,
          "policyId": null,
          "sourceDoc": "Wisconsin_2026_PA_Audit.md",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "Preferred preventive; Gold Card may apply"
        }
      },
      "MI-COM-BCBSMI": {
        "Gepants (Preventive)": {
          "state": "MI",
          "payerName": "BCBS MI",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Preventive)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventives",
          "step1Duration": "≥8 weeks",
          "step2Req": "Fail preferred injectable CGRP (Aimovig/Emgality)",
          "step2Duration": null,
          "quantityLimit": "30 tabs/30 days",
          "contraBypass": "Yes - needle phobia",
          "goldCardAvail": "No",
          "goldCardThresh": null,
          "policyId": null,
          "sourceDoc": "Michigan_2026_PA_Audit.md",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "Step 2 CGRP positioning"
        }
      },
      "MA-MCD-MASSHLTH": {
        "Gepants (Preventive)": {
          "state": "MA",
          "payerName": "MassHealth",
          "payerType": "Medicaid FFS",
          "lob": "Medicaid",
          "drugClass": "Gepants (Preventive)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "Standard CGRP criteria",
          "step1Duration": "≥8 weeks",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "30 tabs/30 days",
          "contraBypass": "Yes - standard",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": null,
          "sourceDoc": "Massachusetts_2026_PA_Audit.md",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "Listed with preventive agents"
        }
      },
      "TN-MCD-TENNCARE": {
        "Gepants (Preventive)": {
          "state": "TN",
          "payerName": "TennCare (OptumRx)",
          "payerType": "Medicaid MCO",
          "lob": "Medicaid",
          "drugClass": "Gepants (Preventive)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "Per state PDL",
          "step1Duration": null,
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "16 tabs/30 days",
          "contraBypass": "Per PDL",
          "goldCardAvail": "No",
          "goldCardThresh": null,
          "policyId": null,
          "sourceDoc": "Tennessee_2026_PA_Audit.md",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "Split benefit - follows state PDL"
        }
      },
      "WY-PARTD-VARIOUS": {
        "Gepants (Preventive)": {
          "state": "WY",
          "payerName": "Medicare Part D",
          "payerType": "Medicare",
          "lob": "Part D",
          "drugClass": "Gepants (Preventive)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "Per formulary tier",
          "step1Duration": null,
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "16 tabs/30 days",
          "contraBypass": null,
          "goldCardAvail": "No",
          "goldCardThresh": null,
          "policyId": null,
          "sourceDoc": "Wyoming_2026_PA_Audit.md",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "Part D covers oral preventives"
        }
      },
      "GA-COM-VARIOUS": {
        "Gepants (Preventive)": {
          "state": "GA",
          "payerName": "Multiple (Anthem/UHC)",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Preventive)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "≥8 weeks",
          "step2Req": "Inferred: Similar to CGRP mAb",
          "step2Duration": null,
          "quantityLimit": "30 tabs/30 days",
          "contraBypass": "Yes - standard CGRP bypasses",
          "goldCardAvail": "No",
          "goldCardThresh": null,
          "policyId": null,
          "sourceDoc": "Georgia_2026_PA_Audit_Strategy.md",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "FALLBACK from CGRP mAb baseline - verify gepant-specific"
        }
      },
      "GA-MCD-AMERIGRP": {
        "Gepants (Preventive)": {
          "state": "GA",
          "payerName": "Georgia Medicaid (Amerigroup)",
          "payerType": "Medicaid MCO",
          "lob": "Medicaid",
          "drugClass": "Gepants (Preventive)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "Per Unified PDL",
          "step1Duration": "≥8 weeks",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "30 tabs/30 days",
          "contraBypass": "Yes - standard",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": null,
          "sourceDoc": "Georgia_2026_PA_Audit_Strategy.md",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "FALLBACK - Unified PDL step therapy"
        }
      },
      "ID-COM-BCIID": {
        "Gepants (Preventive)": {
          "state": "ID",
          "payerName": "Blue Cross Idaho",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Preventive)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "≥8 weeks",
          "step2Req": "Inferred: May require mAb step",
          "step2Duration": null,
          "quantityLimit": "30 tabs/30 days",
          "contraBypass": "Yes - standard CGRP bypasses",
          "goldCardAvail": "No",
          "goldCardThresh": null,
          "policyId": null,
          "sourceDoc": "Idaho_2026_PA_Audit_Strategy.md",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "FALLBACK from CGRP mAb baseline"
        }
      },
      "ID-MCD-IDMED": {
        "Gepants (Preventive)": {
          "state": "ID",
          "payerName": "Idaho Medicaid",
          "payerType": "Medicaid FFS",
          "lob": "Medicaid",
          "drugClass": "Gepants (Preventive)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "Fail 2 oral preventive classes (strict)",
          "step1Duration": "≥8 weeks",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "30 tabs/30 days",
          "contraBypass": "Yes - standard",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": null,
          "sourceDoc": "Idaho_2026_PA_Audit_Strategy.md",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "FALLBACK - strict fail-first policy"
        }
      },
      "IL-MCD-ILHFS": {
        "Gepants (Preventive)": {
          "state": "IL",
          "payerName": "Illinois Medicaid (HFS)",
          "payerType": "Medicaid FFS",
          "lob": "Medicaid",
          "drugClass": "Gepants (Preventive)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "Fail 2 distinct oral preventive classes",
          "step1Duration": "≥8 weeks",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "30 tabs/30 days",
          "contraBypass": "Yes - standard",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": null,
          "sourceDoc": "Illinois_2026_PA_Audit_Strategy.md",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "FALLBACK from CGRP mAb Policy 0970"
        }
      },
      "KY-MCD-KYMED": {
        "Gepants (Preventive)": {
          "state": "KY",
          "payerName": "Kentucky Medicaid (Humana/Passport)",
          "payerType": "Medicaid MCO",
          "lob": "Medicaid",
          "drugClass": "Gepants (Preventive)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "Per state PDL criteria",
          "step1Duration": "≥8 weeks",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "30 tabs/30 days",
          "contraBypass": "Yes - standard",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": null,
          "sourceDoc": "Kentucky_2026_PA_Audit.md",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "FALLBACK - step therapy logic same as CGRP mAb"
        }
      },
      "MT-MCD-MTMED": {
        "Gepants (Preventive)": {
          "state": "MT",
          "payerName": "Montana Medicaid",
          "payerType": "Medicaid FFS",
          "lob": "Medicaid",
          "drugClass": "Gepants (Preventive)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "Fail 2 oral preventive classes",
          "step1Duration": "≥8 weeks",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "30 tabs/30 days",
          "contraBypass": "Yes - standard; no repeat step therapy",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": null,
          "sourceDoc": "Montana_2026_PA_Audit.md",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "FALLBACK - state law prohibits repeat step therapy"
        }
      },
      "NY-MCD-FIDELIS-CLUSTER": {
        "CGRP mAbs (Cluster)": {
          "state": "NY",
          "payerName": "Fidelis Care",
          "payerType": "Medicaid MCO",
          "lob": "Medicaid",
          "drugClass": "CGRP mAbs (Cluster)",
          "medCategory": "Cluster Headache Prevention",
          "stepTherapyRequired": "Yes",
          "step1Req": "Failure of verapamil and/or lithium at therapeutic doses (verapamil ≥240mg/day)",
          "step1Duration": "Documented trial",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Emgality 300mg monthly; ⚠️ The 'Cluster' Loophole: Emgality 300mg is ONLY FDA-approved for episodic cluster - migraine preventive step therapy is clinically invalid for cluster dx",
          "contraBypass": "Yes - documented intolerance to verapamil (bradycardia, heart block, hypotension) or lithium (renal impairment, thyroid dysfunction)",
          "goldCardAvail": "N/A for cluster",
          "goldCardThresh": null,
          "policyId": "Fidelis Cluster Policy",
          "sourceDoc": "New_York_2026_PA_Audit",
          "denialCode": "DENY-CLUSTER-001",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⚠️ CLUSTER HEADACHE - DISTINCT FROM MIGRAINE. Topiramate failure is NOT required as it's a migraine drug. Emgality 300mg = ONLY FDA-approved CGRP for cluster."
        }
      },
      "NY-MCD-NYRX-CLUSTER": {
        "CGRP mAbs (Cluster)": {
          "state": "NY",
          "payerName": "NYRx (Magellan)",
          "payerType": "Medicaid FFS",
          "lob": "Medicaid Pharmacy",
          "drugClass": "CGRP mAbs (Cluster)",
          "medCategory": "Cluster Headache Prevention",
          "stepTherapyRequired": "Yes",
          "step1Req": "Failure of ≥1 conventional cluster preventive (verapamil preferred, then lithium)",
          "step1Duration": "Documented trial at therapeutic doses",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Emgality 300mg monthly; Carved out to state - submit PA to NYRx NOT MCO; ICD-10: G44.011 or G44.019 only",
          "contraBypass": "Yes - documented contraindications to verapamil/lithium",
          "goldCardAvail": null,
          "goldCardThresh": null,
          "policyId": "NYRx Cluster Criteria",
          "sourceDoc": "New_York_2026_PA_Audit",
          "denialCode": "DENY-CLUSTER-001",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "NYRx cluster: Carve-out applies - submit to state Magellan portal, not Fidelis/MCO. Distinct from migraine criteria."
        }
      },
      "CA-MCD-LACARE-CLUSTER": {
        "CGRP mAbs (Cluster)": {
          "state": "CA",
          "payerName": "L.A. Care Health Plan",
          "payerType": "Medicaid MCO",
          "lob": "Medical Benefit",
          "drugClass": "CGRP mAbs (Cluster)",
          "medCategory": "Cluster Headache Prevention",
          "stepTherapyRequired": "Yes",
          "step1Req": "Failure of verapamil ≥240mg/day or lithium (therapeutic serum level 0.6-1.2 mEq/L)",
          "step1Duration": "Documented trial",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Emgality 300mg monthly; ⛔ EPISODIC CLUSTER ONLY (G44.01x); L.A. Care retains medical benefit control even with pharmacy carve-out",
          "contraBypass": "Yes - documented cardiac contraindication to verapamil; renal/thyroid contraindication to lithium",
          "goldCardAvail": "Gold Card tracking begins 2026 per SB 306",
          "goldCardThresh": "Data calibration year",
          "policyId": "L.A. Care Cluster Policy",
          "sourceDoc": "California_2026_PA_Audit",
          "denialCode": "DENY-CLUSTER-001",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "L.A. Care cluster: Medical benefit NOT carved out to Medi-Cal Rx. Submit cluster PA directly to L.A. Care."
        }
      },
      "CA-MCD-MEDICALRX-CLUSTER": {
        "CGRP mAbs (Cluster)": {
          "state": "CA",
          "payerName": "Medi-Cal Rx (DHCS)",
          "payerType": "Medicaid FFS",
          "lob": "Medicaid Pharmacy",
          "drugClass": "CGRP mAbs (Cluster)",
          "medCategory": "Cluster Headache Prevention",
          "stepTherapyRequired": "Yes",
          "step1Req": "Failure of verapamil AND/OR lithium; transitional corticosteroid course may count",
          "step1Duration": "Documented trial",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Emgality 300mg monthly; State-managed pharmacy benefit; ⚠️ Medical benefit (J3590) may require separate LA Care/MCP PA",
          "contraBypass": "Yes - standard cluster preventive contraindications",
          "goldCardAvail": "No state Gold Card",
          "goldCardThresh": null,
          "policyId": "Medi-Cal Rx Cluster Criteria",
          "sourceDoc": "California_2026_PA_Audit",
          "denialCode": "DENY-CLUSTER-001",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "Medi-Cal Rx cluster: Central FFS pharmacy benefit. Episodic cluster only per FDA label."
        }
      },
      "PA-COM-HIGHBCBS-CLUSTER": {
        "CGRP mAbs (Cluster)": {
          "state": "PA",
          "payerName": "Highmark Blue Cross Blue Shield",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (Cluster)",
          "medCategory": "Cluster Headache Prevention",
          "stepTherapyRequired": "Yes",
          "step1Req": "Failure of verapamil (titrated to ≥240mg or max tolerated) OR lithium at therapeutic serum level",
          "step1Duration": "Documented trial",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Emgality 300mg monthly; Act 146 Gold Card tracking applies; ICD-10: G44.011/G44.019",
          "contraBypass": "Yes - bradycardia, heart block, asthma (verapamil); renal impairment, thyroid disorder (lithium)",
          "goldCardAvail": "Act 146 (2026 measurement year)",
          "goldCardThresh": "≥90% approval; exemptions begin 1/1/2027",
          "policyId": "Highmark Cluster Policy",
          "sourceDoc": "Pennsylvania_2026_PA_Audit",
          "denialCode": "DENY-CLUSTER-001",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "Highmark cluster: Step therapy is DISTINCT from migraine. Topiramate/beta-blocker failures do NOT count."
        }
      },
      "DE-COM-HIGHBCBS-CLUSTER": {
        "CGRP mAbs (Cluster)": {
          "state": "DE",
          "payerName": "Highmark BCBS DE",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (Cluster)",
          "medCategory": "Cluster Headache Prevention",
          "stepTherapyRequired": "Yes",
          "step1Req": "Failure of verapamil OR lithium at therapeutic doses",
          "step1Duration": "Documented trial",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Emgality 300mg monthly; Episodic cluster only; Voluntary Gold Card available",
          "contraBypass": "Yes - cardiac/renal/thyroid contraindications",
          "goldCardAvail": "Yes (Voluntary)",
          "goldCardThresh": "90% approval rate",
          "policyId": "Highmark DE Cluster Policy",
          "sourceDoc": "Delaware_2026_PA_Audit",
          "denialCode": "DENY-CLUSTER-001",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "Highmark DE cluster: Delaware 18 Del. C. § 3381 step therapy exemption applies if conventional tx likely ineffective."
        }
      },
      "WI-MCD-FORWARD-CLUSTER": {
        "CGRP mAbs (Cluster)": {
          "state": "WI",
          "payerName": "ForwardHealth (WI Medicaid)",
          "payerType": "Medicaid FFS",
          "lob": "Medicaid",
          "drugClass": "CGRP mAbs (Cluster)",
          "medCategory": "Cluster Headache Prevention",
          "stepTherapyRequired": "Yes",
          "step1Req": "Failure of verapamil (titrated per AHS guidelines) AND/OR lithium",
          "step1Duration": "Documented titration",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Emgality 300mg monthly; ForwardHealth portal PA; ⛔ Episodic cluster only (G44.01x)",
          "contraBypass": "Yes - documented contraindications per AHS 2016 cluster guidelines",
          "goldCardAvail": "N/A for Medicaid",
          "goldCardThresh": null,
          "policyId": "ForwardHealth Cluster Policy",
          "sourceDoc": "Wisconsin_2026_PA_Audit",
          "denialCode": "DENY-CLUSTER-001",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "ForwardHealth cluster: WI SB 434 pending - may affect 2027 PA landscape."
        }
      },
      "TX-MCD-TXMEDICAID-CLUSTER": {
        "CGRP mAbs (Cluster)": {
          "state": "TX",
          "payerName": "Texas Medicaid",
          "payerType": "Medicaid FFS",
          "lob": "Medicaid",
          "drugClass": "CGRP mAbs (Cluster)",
          "medCategory": "Cluster Headache Prevention",
          "stepTherapyRequired": "Yes",
          "step1Req": "Failure of ≥1 conventional cluster preventive (verapamil or lithium)",
          "step1Duration": "Documented trial",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Emgality 300mg monthly; State PDL applies; ⚠️ Claims often require NDC override for 300mg vs 120mg",
          "contraBypass": "Yes - standard contraindications documented",
          "goldCardAvail": "N/A for Medicaid",
          "goldCardThresh": null,
          "policyId": "TX Medicaid Cluster Policy",
          "sourceDoc": "Texas_2026_PA_Audit",
          "denialCode": "DENY-CLUSTER-001",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "Texas Medicaid cluster: Verify NDC for 300mg cluster dose vs 120mg migraine dose on PA."
        }
      },
      "FL-MCD-FLMEDICAID-CLUSTER": {
        "CGRP mAbs (Cluster)": {
          "state": "FL",
          "payerName": "Florida Medicaid (Statewide)",
          "payerType": "Medicaid MCO",
          "lob": "Medicaid",
          "drugClass": "CGRP mAbs (Cluster)",
          "medCategory": "Cluster Headache Prevention",
          "stepTherapyRequired": "Yes",
          "step1Req": "Failure of verapamil ≥240mg/day or lithium therapeutic level",
          "step1Duration": "Documented trial",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Emgality 300mg monthly; FL SMMC unified PDL applies; Episodic cluster only",
          "contraBypass": "Yes - cardiac/renal/thyroid contraindications",
          "goldCardAvail": "N/A for Medicaid",
          "goldCardThresh": null,
          "policyId": "FL Medicaid Cluster Policy",
          "sourceDoc": "Florida_2026_PA_Audit",
          "denialCode": "DENY-CLUSTER-001",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "Florida Medicaid cluster: Statewide PDL governs across all MCOs."
        }
      },
      "AZ-COM-BCBSAZ-CLUSTER": {
        "CGRP mAbs (Cluster)": {
          "state": "AZ",
          "payerName": "BCBS Arizona",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (Cluster)",
          "medCategory": "Cluster Headache Prevention",
          "stepTherapyRequired": "Yes",
          "step1Req": "Failure of verapamil AND/OR lithium; topiramate optional per physician discretion",
          "step1Duration": "Documented trial",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Emgality 300mg monthly; ⚠️ Cluster Headache override can be difficult - document episodic pattern clearly",
          "contraBypass": "Yes - standard contraindications",
          "goldCardAvail": "Yes (Gold Card Program)",
          "goldCardThresh": "80% approval",
          "policyId": "BCBSAZ Cluster Policy",
          "sourceDoc": "Arizona_2026_PA_Audit",
          "denialCode": "DENY-CLUSTER-001",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "BCBSAZ cluster: Distinct criteria from migraine. Document ≥5 attacks in a cluster period."
        }
      },
      "OH-MCD-BUCKEYE-CLUSTER": {
        "CGRP mAbs (Cluster)": {
          "state": "OH",
          "payerName": "Buckeye Health Plan",
          "payerType": "Medicaid MCO",
          "lob": "Medicaid",
          "drugClass": "CGRP mAbs (Cluster)",
          "medCategory": "Cluster Headache Prevention",
          "stepTherapyRequired": "Yes",
          "step1Req": "Failure of verapamil (titrated appropriately) OR lithium",
          "step1Duration": "Documented trial",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Emgality 300mg monthly; OH Medicaid unified PDL applies; Episodic cluster only (G44.01x)",
          "contraBypass": "Yes - documented cardiac/renal contraindications",
          "goldCardAvail": "N/A for Medicaid",
          "goldCardThresh": null,
          "policyId": "Buckeye Cluster Policy",
          "sourceDoc": "Ohio_2026_PA_Audit",
          "denialCode": "DENY-CLUSTER-001",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "OH Medicaid cluster: HB 122 Gold Card law applies to commercial only, not Medicaid."
        }
      },
      "VA-COM-ANTHEM-CLUSTER": {
        "CGRP mAbs (Cluster)": {
          "state": "VA",
          "payerName": "Anthem HealthKeepers",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (Cluster)",
          "medCategory": "Cluster Headache Prevention",
          "stepTherapyRequired": "Yes",
          "step1Req": "Failure of ≥1 conventional cluster preventive (verapamil, lithium, or topiramate)",
          "step1Duration": "Documented trial",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Emgality 300mg monthly; VA § 38.2-3407.15:8 Gold Card eligibility tracking applies",
          "contraBypass": "Yes - documented contraindications to all three conventional agents",
          "goldCardAvail": "VA Gold Card Law (2027 implementation)",
          "goldCardThresh": "Per HB 2099",
          "policyId": "Anthem HealthKeepers Cluster Policy",
          "sourceDoc": "Virginia_2026_PA_Audit",
          "denialCode": "DENY-CLUSTER-001",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "Anthem VA cluster: Document episodic pattern (attacks in bouts with remission periods ≥3 months)."
        }
      },
      "WA-COM-PREMERA-CLUSTER": {
        "CGRP mAbs (Cluster)": {
          "state": "WA",
          "payerName": "Premera BCBS WA",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (Cluster)",
          "medCategory": "Cluster Headache Prevention",
          "stepTherapyRequired": "Yes",
          "step1Req": "Failure of verapamil or lithium at therapeutic doses",
          "step1Duration": "Documented trial",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Emgality 300mg monthly; Policy 5.01.503 covers cluster; Episodic cluster only per FDA",
          "contraBypass": "Yes - cardiac (verapamil) or renal/thyroid (lithium) contraindications",
          "goldCardAvail": "N/A for cluster",
          "goldCardThresh": null,
          "policyId": "Premera WA Cluster Policy",
          "sourceDoc": "Washington_State_PA_Audit",
          "denialCode": "DENY-CLUSTER-001",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "Premera WA cluster: Per policy 5.01.503, cluster criteria are separate from migraine."
        }
      },
      "OR-COM-MODA-CLUSTER": {
        "CGRP mAbs (Cluster)": {
          "state": "OR",
          "payerName": "Moda Health",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (Cluster)",
          "medCategory": "Cluster Headache Prevention",
          "stepTherapyRequired": "Yes",
          "step1Req": "Failure of verapamil ≥240mg/day (or max tolerated dose)",
          "step1Duration": "Documented titration",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Emgality 300mg monthly; ⚠️ Moda requires documented titration schedule for verapamil",
          "contraBypass": "Yes - documented intolerance or contraindication",
          "goldCardAvail": "N/A for cluster",
          "goldCardThresh": null,
          "policyId": "Moda Cluster Policy",
          "sourceDoc": "Oregon_2026_PA_Audit",
          "denialCode": "DENY-CLUSTER-001",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "Moda cluster: Document specific verapamil titration - 'tried 120mg' will be denied."
        }
      },
      "AK-COM-PREMERA-CLUSTER": {
        "CGRP mAbs (Cluster)": {
          "state": "AK",
          "payerName": "Premera BCBS AK",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (Cluster)",
          "medCategory": "Cluster Headache Prevention",
          "stepTherapyRequired": "Yes",
          "step1Req": "Failure of verapamil or lithium at therapeutic doses per AHS cluster guidelines",
          "step1Duration": "Documented trial",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Emgality 300mg monthly; Policy 5.01.503 applies; SB 133 PA reform effective 2027",
          "contraBypass": "Yes - documented cardiac/renal/thyroid contraindications",
          "goldCardAvail": "SB 133 future",
          "goldCardThresh": null,
          "policyId": "Premera AK Cluster Policy",
          "sourceDoc": "Alaska_2026_PA_Audit",
          "denialCode": "DENY-CLUSTER-001",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "Premera AK cluster: Per policy 5.01.503, cluster headache criteria are distinct from migraine criteria."
        }
      },
      "HI-COM-HMSA-CLUSTER": {
        "CGRP mAbs (Cluster)": {
          "state": "HI",
          "payerName": "HMSA",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (Cluster)",
          "medCategory": "Cluster Headache Prevention",
          "stepTherapyRequired": "Yes",
          "step1Req": "Failure of verapamil (≥240mg/day) and/or lithium; may also require Noridian alignment for Part B",
          "step1Duration": "Documented trial",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Emgality 300mg monthly; HMSA medical policy aligns with Noridian JE LCD",
          "contraBypass": "Yes - cardiac/renal/thyroid contraindications",
          "goldCardAvail": "N/A for cluster",
          "goldCardThresh": null,
          "policyId": "HMSA Cluster Policy",
          "sourceDoc": "Hawaii_2026_PA_Audit",
          "denialCode": "DENY-CLUSTER-001",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "HMSA cluster: May require concurrent Noridian MAC documentation for Medicare crossover patients."
        }
      },
      "NV-MCD-NVMEDICAID-CLUSTER": {
        "CGRP mAbs (Cluster)": {
          "state": "NV",
          "payerName": "Nevada Medicaid (DHCFP)",
          "payerType": "Medicaid FFS",
          "lob": "Medicaid",
          "drugClass": "CGRP mAbs (Cluster)",
          "medCategory": "Cluster Headache Prevention",
          "stepTherapyRequired": "Yes",
          "step1Req": "Failure of verapamil (appropriately titrated) OR lithium at therapeutic serum level",
          "step1Duration": "Documented trial",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Emgality 300mg monthly; State PDL criteria; Episodic cluster only (G44.01x)",
          "contraBypass": "Yes - documented cardiac/renal/thyroid contraindications",
          "goldCardAvail": "N/A for Medicaid",
          "goldCardThresh": null,
          "policyId": "NV Medicaid Cluster Policy",
          "sourceDoc": "Nevada_2026_PA_Audit",
          "denialCode": "DENY-CLUSTER-001",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "NV Medicaid cluster: Verify PDL status for Emgality 300mg vs 120mg dosing."
        }
      },
      "CO-MCD-COMEDICAID-CLUSTER": {
        "CGRP mAbs (Cluster)": {
          "state": "CO",
          "payerName": "Colorado Medicaid",
          "payerType": "Medicaid FFS",
          "lob": "Medicaid",
          "drugClass": "CGRP mAbs (Cluster)",
          "medCategory": "Cluster Headache Prevention",
          "stepTherapyRequired": "Yes",
          "step1Req": "Failure of ≥1 conventional cluster preventive (verapamil or lithium)",
          "step1Duration": "Documented trial",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Emgality 300mg monthly; CO Gold Card exemptions (commercial) per SB21-023 do NOT apply to Medicaid",
          "contraBypass": "Yes - documented contraindications",
          "goldCardAvail": "N/A for Medicaid",
          "goldCardThresh": null,
          "policyId": "CO Medicaid Cluster Policy",
          "sourceDoc": "Colorado_2026_PA_Audit",
          "denialCode": "DENY-CLUSTER-001",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "CO Medicaid cluster: Commercial Gold Card exemptions do not apply to Medicaid cluster headache PAs."
        }
      },
      "NM-COM-BCBSNM-CLUSTER": {
        "CGRP mAbs (Cluster)": {
          "state": "NM",
          "payerName": "BCBS New Mexico",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (Cluster)",
          "medCategory": "Cluster Headache Prevention",
          "stepTherapyRequired": "Yes",
          "step1Req": "Failure of verapamil OR lithium at therapeutic doses",
          "step1Duration": "Documented trial",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Emgality 300mg monthly; Episodic cluster diagnosis required; HB 246 step therapy law applies",
          "contraBypass": "Yes - documented cardiac/renal contraindications",
          "goldCardAvail": "Yes per HB 246",
          "goldCardThresh": "TBD 2027",
          "policyId": "BCBSNM Cluster Policy",
          "sourceDoc": "New_Mexico_2026_PA_Audit",
          "denialCode": "DENY-CLUSTER-001",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "BCBS NM cluster: HB 246 step therapy reform may provide additional cluster bypass options."
        }
      },
      "KS-MCD-SUNFLOWER-CLUSTER": {
        "CGRP mAbs (Cluster)": {
          "state": "KS",
          "payerName": "Sunflower Health Plan",
          "payerType": "Medicaid MCO",
          "lob": "Medicaid",
          "drugClass": "CGRP mAbs (Cluster)",
          "medCategory": "Cluster Headache Prevention",
          "stepTherapyRequired": "Yes",
          "step1Req": "Failure of verapamil at ≥240mg/day or therapeutic dose per cardiology consultation",
          "step1Duration": "Documented titration",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Emgality 300mg monthly; KS KDHE PDL applies; ⚠️ KDHE 2026 criteria update pending verification",
          "contraBypass": "Yes - documented cardiac contraindication",
          "goldCardAvail": "N/A for Medicaid",
          "goldCardThresh": null,
          "policyId": "Sunflower Cluster Policy",
          "sourceDoc": "Kansas_PA_Audit",
          "denialCode": "DENY-CLUSTER-001",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "Sunflower KS cluster: Verify KDHE PDL criteria for 2026 - criteria may have updated."
        }
      },
      "NH-MCD-AMERIHEALTH": {
        "Gepants (Acute)": {
          "state": "NH",
          "payerName": "AmeriHealth Caritas NH",
          "payerType": "Medicaid MCO",
          "lob": "Medicaid",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "⚠️ FLAG: Inferred from NH Medicaid baseline — verify with AmeriHealth PA criteria",
          "step1Duration": "Verify",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Per NH Medicaid PDL",
          "contraBypass": "Yes - standard",
          "goldCardAvail": "N/A - Medicaid",
          "goldCardThresh": null,
          "policyId": "⚠️ NEEDS VERIFICATION",
          "sourceDoc": "INFERRED — Not in NH Audit (audit covers Centene only)",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⚠️ NEEDS MANUAL REVIEW — AmeriHealth not in NH audit"
        },
        "CGRP mAbs (SC)": {
          "state": "NH",
          "payerName": "AmeriHealth Caritas NH",
          "payerType": "Medicaid MCO",
          "lob": "Medicaid",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "⚠️ FLAG: Inferred from NH Medicaid baseline — verify with AmeriHealth PA criteria",
          "step1Duration": "Verify",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Per NH Medicaid PDL",
          "contraBypass": "Yes - standard",
          "goldCardAvail": "N/A - Medicaid",
          "goldCardThresh": null,
          "policyId": "⚠️ NEEDS VERIFICATION",
          "sourceDoc": "INFERRED — Not in NH Audit (audit covers Centene only)",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⚠️ NEEDS MANUAL REVIEW — AmeriHealth not in NH audit"
        },
        "Neurotoxins": {
          "state": "NH",
          "payerName": "AmeriHealth Caritas NH",
          "payerType": "Medicaid MCO",
          "lob": "Medicaid",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "⚠️ FLAG: Inferred from NH Medicaid baseline — verify with AmeriHealth PA criteria",
          "step1Duration": "Verify",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Per NH Medicaid PDL",
          "contraBypass": "Yes - standard",
          "goldCardAvail": "N/A - Medicaid",
          "goldCardThresh": null,
          "policyId": "⚠️ NEEDS VERIFICATION",
          "sourceDoc": "INFERRED — Not in NH Audit (audit covers Centene only)",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA."
        }
      },
      "NH-MCD-WELLSENSE": {
        "Gepants (Acute)": {
          "state": "NH",
          "payerName": "Well Sense Health Plan NH",
          "payerType": "Medicaid MCO",
          "lob": "Medicaid",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "⚠️ FLAG: Inferred from NH Medicaid baseline — verify with WellSense PA criteria",
          "step1Duration": "Verify",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Per NH Medicaid PDL",
          "contraBypass": "Yes - standard",
          "goldCardAvail": "N/A - Medicaid",
          "goldCardThresh": null,
          "policyId": "⚠️ NEEDS VERIFICATION",
          "sourceDoc": "INFERRED — Not in NH Audit (audit covers Centene only)",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⚠️ NEEDS MANUAL REVIEW — WellSense not in NH audit"
        },
        "CGRP mAbs (SC)": {
          "state": "NH",
          "payerName": "Well Sense Health Plan NH",
          "payerType": "Medicaid MCO",
          "lob": "Medicaid",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "⚠️ FLAG: Inferred from NH Medicaid baseline — verify with WellSense PA criteria",
          "step1Duration": "Verify",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Per NH Medicaid PDL",
          "contraBypass": "Yes - standard",
          "goldCardAvail": "N/A - Medicaid",
          "goldCardThresh": null,
          "policyId": "⚠️ NEEDS VERIFICATION",
          "sourceDoc": "INFERRED — Not in NH Audit (audit covers Centene only)",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⚠️ NEEDS MANUAL REVIEW — WellSense not in NH audit"
        },
        "Neurotoxins": {
          "state": "NH",
          "payerName": "Well Sense Health Plan NH",
          "payerType": "Medicaid MCO",
          "lob": "Medicaid",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "⚠️ FLAG: Inferred from NH Medicaid baseline — verify with WellSense PA criteria",
          "step1Duration": "Verify",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Per NH Medicaid PDL",
          "contraBypass": "Yes - standard",
          "goldCardAvail": "N/A - Medicaid",
          "goldCardThresh": null,
          "policyId": "⚠️ NEEDS VERIFICATION",
          "sourceDoc": "Q1-2026-Policy-Refresh",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "Updated Utilization Management Medical Policy via CCUM"
        }
      },
      "NH-COM-AETNA": {
        "Gepants (Acute)": {
          "state": "NH",
          "payerName": "Aetna NH",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 preferred triptans (national Aetna baseline)",
          "step1Duration": "Trial required",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Per national Aetna formulary",
          "contraBypass": "Yes - CV contraindication",
          "goldCardAvail": "⚠️ SB 561 applies",
          "goldCardThresh": "2 biz days",
          "policyId": "National Aetna Policy",
          "sourceDoc": "NATIONAL_BASELINE — Aetna not profiled in NH audit",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "NATIONAL BASELINE — verify with state-specific filing"
        },
        "CGRP mAbs (SC)": {
          "state": "NH",
          "payerName": "Aetna NH",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes (national Aetna baseline)",
          "step1Duration": "≥8 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Per national Aetna formulary",
          "contraBypass": "Yes - standard",
          "goldCardAvail": "⚠️ SB 561 applies",
          "goldCardThresh": "2 biz days",
          "policyId": "National Aetna Policy",
          "sourceDoc": "NATIONAL_BASELINE — Aetna not profiled in NH audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "NATIONAL BASELINE — verify with state-specific filing"
        },
        "Neurotoxins": {
          "state": "NH",
          "payerName": "Aetna NH",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "≥8 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Per national Aetna formulary",
          "contraBypass": "Yes - standard",
          "goldCardAvail": "⚠️ SB 561 applies",
          "goldCardThresh": "2 biz days",
          "policyId": "National Aetna Policy",
          "sourceDoc": "NATIONAL_BASELINE — Aetna not profiled in NH audit",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA."
        }
      },
      "NH-COM-CIGNA": {
        "Gepants (Acute)": {
          "state": "NH",
          "payerName": "Cigna NH",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 preferred triptans (national Cigna/ESI baseline)",
          "step1Duration": "Trial required",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Per national Cigna/Express Scripts formulary",
          "contraBypass": "Yes - CV contraindication",
          "goldCardAvail": "⚠️ SB 561 applies",
          "goldCardThresh": "2 biz days",
          "policyId": "National Cigna/ESI Policy",
          "sourceDoc": "NATIONAL_BASELINE — Cigna mentioned in NH audit §1.3 but no deep-dive",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "NATIONAL BASELINE — verify with state-specific filing"
        },
        "CGRP mAbs (SC)": {
          "state": "NH",
          "payerName": "Cigna NH",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes (national Cigna/ESI baseline)",
          "step1Duration": "≥8 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Per national Cigna/Express Scripts formulary",
          "contraBypass": "Yes - standard",
          "goldCardAvail": "⚠️ SB 561 applies",
          "goldCardThresh": "2 biz days",
          "policyId": "National Cigna/ESI Policy",
          "sourceDoc": "NATIONAL_BASELINE — Cigna mentioned in NH audit §1.3 but no deep-dive",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "NATIONAL BASELINE — verify with state-specific filing"
        },
        "Neurotoxins": {
          "state": "NH",
          "payerName": "Cigna NH",
          "payerType": "Commercial",
          "lob": "Commercial",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "≥8 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Per national Cigna/Express Scripts formulary",
          "contraBypass": "Yes - standard",
          "goldCardAvail": "⚠️ SB 561 applies",
          "goldCardThresh": "2 biz days",
          "policyId": "National Cigna/ESI Policy",
          "sourceDoc": "NATIONAL_BASELINE — Cigna mentioned in NH audit §1.3 but no deep-dive",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA."
        }
      },
      "NH-COM-AMBETTER": {
        "Gepants (Acute)": {
          "state": "NH",
          "payerName": "Ambetter New Hampshire",
          "payerType": "ACA Exchange",
          "lob": "Commercial",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 preferred triptans (Centene/Ambetter baseline)",
          "step1Duration": "Trial required",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Per Centene/Ambetter formulary",
          "contraBypass": "Yes - CV contraindication",
          "goldCardAvail": "⚠️ SB 561 applies",
          "goldCardThresh": "2 biz days",
          "policyId": "Centene/Ambetter Policy",
          "sourceDoc": "NATIONAL_BASELINE — NH audit §1.3 mentions Ambetter but no deep-dive",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "NATIONAL BASELINE — same Centene infrastructure as NH Healthy Families"
        },
        "CGRP mAbs (SC)": {
          "state": "NH",
          "payerName": "Ambetter New Hampshire",
          "payerType": "ACA Exchange",
          "lob": "Commercial",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes (Centene baseline)",
          "step1Duration": "≥8 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Per Centene/Ambetter formulary",
          "contraBypass": "Yes - standard",
          "goldCardAvail": "⚠️ SB 561 applies",
          "goldCardThresh": "2 biz days",
          "policyId": "Centene/Ambetter Policy",
          "sourceDoc": "NATIONAL_BASELINE — NH audit §1.3 mentions Ambetter but no deep-dive",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "NATIONAL BASELINE — same Centene infrastructure as NH Healthy Families"
        },
        "Neurotoxins": {
          "state": "NH",
          "payerName": "Ambetter New Hampshire",
          "payerType": "ACA Exchange",
          "lob": "Commercial",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes",
          "step1Duration": "≥8 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Per Centene/Ambetter formulary",
          "contraBypass": "Yes - standard",
          "goldCardAvail": "⚠️ SB 561 applies",
          "goldCardThresh": "2 biz days",
          "policyId": "Centene/Ambetter Policy",
          "sourceDoc": "NATIONAL_BASELINE — NH audit §1.3 mentions Ambetter but no deep-dive",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA."
        }
      },
      "NH-CHIP-NHHF": {
        "Gepants (Acute)": {
          "state": "NH",
          "payerName": "NH Healthy Kids (CHIP)",
          "payerType": "CHIP",
          "lob": "CHIP",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 preferred triptans (NH PDL via Centene)",
          "step1Duration": "Documented",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Per NH Medicaid PDL — CHIP inherits MCO criteria",
          "contraBypass": "Yes - standard",
          "goldCardAvail": "N/A - CHIP",
          "goldCardThresh": null,
          "policyId": "NH PDL (CHIP)",
          "sourceDoc": "INFERRED — CHIP uses NH Healthy Families (Centene) MCO policies",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⚠️ CHIP/Pediatric — verify age limits with NH DHHS"
        },
        "CGRP mAbs (SC)": {
          "state": "NH",
          "payerName": "NH Healthy Kids (CHIP)",
          "payerType": "CHIP",
          "lob": "CHIP",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 different oral preventive classes (NH PDL)",
          "step1Duration": "≥8 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Per NH Medicaid PDL — CHIP inherits MCO criteria",
          "contraBypass": "Yes - standard",
          "goldCardAvail": "N/A - CHIP",
          "goldCardThresh": null,
          "policyId": "NH PDL (CHIP)",
          "sourceDoc": "INFERRED — CHIP uses NH Healthy Families (Centene) MCO policies",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⚠️ CHIP/Pediatric — verify age limits with NH DHHS"
        },
        "Neurotoxins": {
          "state": "NH",
          "payerName": "NH Healthy Kids (CHIP)",
          "payerType": "CHIP",
          "lob": "CHIP",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes (NH PDL)",
          "step1Duration": "≥8 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Per NH Medicaid PDL — CHIP inherits MCO criteria",
          "contraBypass": "Yes - standard",
          "goldCardAvail": "N/A - CHIP",
          "goldCardThresh": null,
          "policyId": "NH PDL (CHIP)",
          "sourceDoc": "INFERRED — CHIP uses NH Healthy Families (Centene) MCO policies",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA. ⚠️ PEDIATRIC: Age restrictions may apply."
        }
      },
      "NH-MA-AETNACARE": {
        "Gepants (Acute)": {
          "state": "NH",
          "payerName": "Aetna Medicare NH",
          "payerType": "Medicare Advantage",
          "lob": "MA",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥1-2 preferred triptans (national Aetna MA baseline)",
          "step1Duration": "Trial required",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Per CVS Caremark MA formulary; ⚠️ $2,100 Part D OOP Cap (IRA) — oral CGRPs more viable post-cap",
          "contraBypass": "Yes - CV contraindication",
          "goldCardAvail": "N/A - Federal/MA",
          "goldCardThresh": null,
          "policyId": "National Aetna MA Policy",
          "sourceDoc": "NATIONAL_BASELINE — NH audit mentions $2,100 cap impact (§2.1) but no MA-specific deep-dive",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "NATIONAL BASELINE — verify with CVS Caremark MA formulary"
        },
        "CGRP mAbs (SC)": {
          "state": "NH",
          "payerName": "Aetna Medicare NH",
          "payerType": "Medicare Advantage",
          "lob": "MA",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes (national Aetna MA baseline)",
          "step1Duration": "≥8 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Per CVS Caremark MA formulary; ⚠️ $2,100 Part D OOP Cap (IRA) — oral CGRPs more viable post-cap",
          "contraBypass": "Yes - standard",
          "goldCardAvail": "N/A - Federal/MA",
          "goldCardThresh": null,
          "policyId": "National Aetna MA Policy",
          "sourceDoc": "NATIONAL_BASELINE — NH audit mentions $2,100 cap impact (§2.1) but no MA-specific deep-dive",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "NATIONAL BASELINE — verify with CVS Caremark MA formulary"
        },
        "Neurotoxins": {
          "state": "NH",
          "payerName": "Aetna Medicare NH",
          "payerType": "Medicare Advantage",
          "lob": "MA",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes + chronic migraine dx",
          "step1Duration": "Documented",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Per CVS Caremark MA formulary; ⚠️ $2,100 Part D OOP Cap (IRA) — oral CGRPs more viable post-cap",
          "contraBypass": "Yes - standard",
          "goldCardAvail": "N/A - Federal/MA",
          "goldCardThresh": null,
          "policyId": "National Aetna MA Policy",
          "sourceDoc": "NATIONAL_BASELINE — NH audit mentions $2,100 cap impact (§2.1) but no MA-specific deep-dive",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA."
        }
      },
      "NH-MA-ELEV": {
        "Gepants (Acute)": {
          "state": "NH",
          "payerName": "Anthem MA NH",
          "payerType": "Medicare Advantage",
          "lob": "MA",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥1-2 preferred triptans (national Anthem MA baseline)",
          "step1Duration": "Trial required",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Per CarelonRx MA formulary; ⚠️ $2,100 Part D OOP Cap (IRA) — oral CGRPs more viable post-cap",
          "contraBypass": "Yes - CV contraindication",
          "goldCardAvail": "N/A - Federal/MA",
          "goldCardThresh": null,
          "policyId": "National Anthem MA Policy",
          "sourceDoc": "NATIONAL_BASELINE — NH audit mentions $2,100 cap impact (§2.1) but no MA-specific deep-dive",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "NATIONAL BASELINE — verify with CarelonRx MA formulary"
        },
        "CGRP mAbs (SC)": {
          "state": "NH",
          "payerName": "Anthem MA NH",
          "payerType": "Medicare Advantage",
          "lob": "MA",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes (national Anthem MA baseline)",
          "step1Duration": "≥8 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Per CarelonRx MA formulary; ⚠️ $2,100 Part D OOP Cap (IRA) — oral CGRPs more viable post-cap",
          "contraBypass": "Yes - standard",
          "goldCardAvail": "N/A - Federal/MA",
          "goldCardThresh": null,
          "policyId": "National Anthem MA Policy",
          "sourceDoc": "NATIONAL_BASELINE — NH audit mentions $2,100 cap impact (§2.1) but no MA-specific deep-dive",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "NATIONAL BASELINE — verify with CarelonRx MA formulary"
        },
        "Neurotoxins": {
          "state": "NH",
          "payerName": "Anthem MA NH",
          "payerType": "Medicare Advantage",
          "lob": "MA",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes + chronic migraine dx",
          "step1Duration": "Documented",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Per CarelonRx MA formulary; ⚠️ $2,100 Part D OOP Cap (IRA) — oral CGRPs more viable post-cap",
          "contraBypass": "Yes - standard",
          "goldCardAvail": "N/A - Federal/MA",
          "goldCardThresh": null,
          "policyId": "National Anthem MA Policy",
          "sourceDoc": "NATIONAL_BASELINE — NH audit mentions $2,100 cap impact (§2.1) but no MA-specific deep-dive",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA."
        }
      },
      "NH-MA-HUMANA": {
        "Gepants (Acute)": {
          "state": "NH",
          "payerName": "Humana MA NH",
          "payerType": "Medicare Advantage",
          "lob": "MA",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥1-2 preferred triptans (national Humana MA baseline)",
          "step1Duration": "Trial required",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Per Humana Pharmacy Solutions MA formulary; ⚠️ $2,100 Part D OOP Cap (IRA) — oral CGRPs more viable post-cap",
          "contraBypass": "Yes - CV contraindication",
          "goldCardAvail": "N/A - Federal/MA",
          "goldCardThresh": null,
          "policyId": "National Humana MA Policy",
          "sourceDoc": "NATIONAL_BASELINE — NH audit mentions $2,100 cap impact (§2.1) but no MA-specific deep-dive",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "NATIONAL BASELINE — verify with Humana Pharmacy Solutions MA formulary"
        },
        "CGRP mAbs (SC)": {
          "state": "NH",
          "payerName": "Humana MA NH",
          "payerType": "Medicare Advantage",
          "lob": "MA",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes (national Humana MA baseline)",
          "step1Duration": "≥8 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Per Humana Pharmacy Solutions MA formulary; ⚠️ $2,100 Part D OOP Cap (IRA) — oral CGRPs more viable post-cap",
          "contraBypass": "Yes - standard",
          "goldCardAvail": "N/A - Federal/MA",
          "goldCardThresh": null,
          "policyId": "National Humana MA Policy",
          "sourceDoc": "NATIONAL_BASELINE — NH audit mentions $2,100 cap impact (§2.1) but no MA-specific deep-dive",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "NATIONAL BASELINE — verify with Humana Pharmacy Solutions MA formulary"
        },
        "Neurotoxins": {
          "state": "NH",
          "payerName": "Humana MA NH",
          "payerType": "Medicare Advantage",
          "lob": "MA",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes + chronic migraine dx",
          "step1Duration": "Documented",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Per Humana Pharmacy Solutions MA formulary; ⚠️ $2,100 Part D OOP Cap (IRA) — oral CGRPs more viable post-cap",
          "contraBypass": "Yes - standard",
          "goldCardAvail": "N/A - Federal/MA",
          "goldCardThresh": null,
          "policyId": "National Humana MA Policy",
          "sourceDoc": "NATIONAL_BASELINE — NH audit mentions $2,100 cap impact (§2.1) but no MA-specific deep-dive",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA."
        }
      },
      "NH-MA-UHC": {
        "Gepants (Acute)": {
          "state": "NH",
          "payerName": "UnitedHealthcare MA NH",
          "payerType": "Medicare Advantage",
          "lob": "MA",
          "drugClass": "Gepants (Acute)",
          "medCategory": "Acute",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥1-2 preferred triptans (national UnitedHealthcare MA baseline)",
          "step1Duration": "Trial required",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Per OptumRx MA formulary; ⚠️ $2,100 Part D OOP Cap (IRA) — oral CGRPs more viable post-cap",
          "contraBypass": "Yes - CV contraindication",
          "goldCardAvail": "N/A - Federal/MA",
          "goldCardThresh": null,
          "policyId": "National UnitedHealthcare MA Policy",
          "sourceDoc": "NATIONAL_BASELINE — NH audit mentions $2,100 cap impact (§2.1) but no MA-specific deep-dive",
          "denialCode": "DENY-STEP-001",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "NATIONAL BASELINE — verify with OptumRx MA formulary"
        },
        "CGRP mAbs (SC)": {
          "state": "NH",
          "payerName": "UnitedHealthcare MA NH",
          "payerType": "Medicare Advantage",
          "lob": "MA",
          "drugClass": "CGRP mAbs (SC)",
          "medCategory": "Preventive",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes (national UnitedHealthcare MA baseline)",
          "step1Duration": "≥8 weeks each",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Per OptumRx MA formulary; ⚠️ $2,100 Part D OOP Cap (IRA) — oral CGRPs more viable post-cap",
          "contraBypass": "Yes - standard",
          "goldCardAvail": "N/A - Federal/MA",
          "goldCardThresh": null,
          "policyId": "National UnitedHealthcare MA Policy",
          "sourceDoc": "NATIONAL_BASELINE — NH audit mentions $2,100 cap impact (§2.1) but no MA-specific deep-dive",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "True",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "NATIONAL BASELINE — verify with OptumRx MA formulary"
        },
        "Neurotoxins": {
          "state": "NH",
          "payerName": "UnitedHealthcare MA NH",
          "payerType": "Medicare Advantage",
          "lob": "MA",
          "drugClass": "Neurotoxins",
          "medCategory": "Chronic Migraine",
          "stepTherapyRequired": "Yes",
          "step1Req": "≥2 oral preventive classes + chronic migraine dx",
          "step1Duration": "Documented",
          "step2Req": null,
          "step2Duration": null,
          "quantityLimit": "Per OptumRx MA formulary; ⚠️ $2,100 Part D OOP Cap (IRA) — oral CGRPs more viable post-cap",
          "contraBypass": "Yes - standard",
          "goldCardAvail": "N/A - Federal/MA",
          "goldCardThresh": null,
          "policyId": "National UnitedHealthcare MA Policy",
          "sourceDoc": "NATIONAL_BASELINE — NH audit mentions $2,100 cap impact (§2.1) but no MA-specific deep-dive",
          "denialCode": "DENY-STEP-002",
          "episodicSameAsChronic": "False",
          "highFreqEpisodicThresh": null,
          "episodicNotes": "⛔ BOTOX = CHRONIC MIGRAINE ONLY per FDA."
        }
      }
    },
    "formulary_tier_map": {
      "AK-COM-AETNA": {
        "Aimovig": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "15/30 days",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AK audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AK audit doc"
        }
      },
      "AK-COM-MODA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "MedImpact",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from MedImpact national formulary; verify via payer portal"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "MedImpact",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from MedImpact national formulary; verify via payer portal"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "MedImpact",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from MedImpact national formulary; verify via payer portal"
        }
      },
      "AK-COM-PREMBC": {
        "Aimovig": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Prime Therapeutics national formulary; verify via payer portal"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Prime Therapeutics national formulary; verify via payer portal"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "15/30 days",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AK audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Prime Therapeutics national formulary; verify via payer portal"
        },
        "Nurtec ODT": {
          "status": "",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ubrelvy": {
          "status": "",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": ""
        }
      },
      "AK-COM-PREMERA": {
        "Aimovig": {
          "status": "",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Premera PBM",
          "confidence": "Gap-Manual-Review",
          "notes": "No audit data or PBM match; PBM=Premera PBM; requires manual verification"
        },
        "Ajovy": {
          "status": "",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Premera PBM",
          "confidence": "Gap-Manual-Review",
          "notes": "No audit data or PBM match; PBM=Premera PBM; requires manual verification"
        },
        "Emgality": {
          "status": "",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Premera PBM",
          "confidence": "Gap-Manual-Review",
          "notes": "No audit data or PBM match; PBM=Premera PBM; requires manual verification"
        },
        "Nurtec ODT": {
          "status": "",
          "tier": "Tier 3",
          "qty": "18/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Premera PBM",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Qulipta": {
          "status": "",
          "tier": "",
          "qty": "30/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Premera PBM",
          "confidence": "Gap-Manual-Review",
          "notes": "No audit data or PBM match; PBM=Premera PBM; requires manual verification"
        },
        "Ubrelvy": {
          "status": "",
          "tier": "Tier 3",
          "qty": "18/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Premera PBM",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Emgality (Cluster)": {
          "status": "Restricted",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "| Remapped from AK-COM-PREMERA-CLUSTER (cluster variant)"
        }
      },
      "AK-COM-UHC": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from OptumRx national formulary; verify via payer portal"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from OptumRx national formulary; verify via payer portal"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from OptumRx national formulary; verify via payer portal"
        },
        "Zavzpret": {
          "status": "",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Tier 4"
        }
      },
      "AK-MA-AETNACARE": {
        "Aimovig": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "15/30 days",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AK audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AK audit doc"
        }
      },
      "AK-MA-HUMANA": {
        "Aimovig": {
          "status": "Not Covered",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Nonformulary (Not covered)"
        },
        "Ajovy": {
          "status": "Not Covered",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Nonformulary (Not covered)"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "15/30 days",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AK audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Not Covered",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Nonformulary (Not covered)"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Not Covered",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Nonformulary (Not covered)"
        }
      },
      "AK-MA-PREMERA": {
        "Aimovig": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "15/30 days",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AK audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AK audit doc"
        }
      },
      "AK-MA-UHC": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "15/30 days",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AK audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AK audit doc"
        }
      },
      "AK-MAC-NORIDIAN": {
        "Botox": {
          "status": "",
          "tier": "",
          "qty": "15/30 days",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "N/A - Medical Benefit",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        }
      },
      "AK-MCD-DENALI": {
        "Aimovig": {
          "status": "",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "AK Medicaid PBM",
          "confidence": "Gap-Manual-Review",
          "notes": "No audit data or PBM match; PBM=AK Medicaid PBM; requires manual verification"
        },
        "Ajovy": {
          "status": "",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "AK Medicaid PBM",
          "confidence": "Gap-Manual-Review",
          "notes": "No audit data or PBM match; PBM=AK Medicaid PBM; requires manual verification"
        },
        "Botox": {
          "status": "",
          "tier": "",
          "qty": "15/30 days",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "AK Medicaid PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        },
        "Emgality": {
          "status": "",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "AK Medicaid PBM",
          "confidence": "Gap-Manual-Review",
          "notes": "No audit data or PBM match; PBM=AK Medicaid PBM; requires manual verification"
        },
        "Nurtec ODT": {
          "status": "",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "AK Medicaid PBM",
          "confidence": "Gap-Manual-Review",
          "notes": "No audit data or PBM match; PBM=AK Medicaid PBM; requires manual verification"
        },
        "Ubrelvy": {
          "status": "",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "AK Medicaid PBM",
          "confidence": "Gap-Manual-Review",
          "notes": "No audit data or PBM match; PBM=AK Medicaid PBM; requires manual verification"
        }
      },
      "AK-PARTB-NORIDIAN": {
        "Botox": {
          "status": "",
          "tier": "",
          "qty": "15/30 days",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        }
      },
      "AL-COM-BCBSAL": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AL audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "Fail Aimovig first",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AL audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "Step within class: Emgality/Ajovy",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AL audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AL audit doc"
        },
        "Qulipta": {
          "status": "",
          "tier": "Tier 2",
          "qty": "30/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AL audit doc"
        },
        "Zavzpret": {
          "status": "Not Covered",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: NC (Not Covered)"
        }
      },
      "AL-COM-UHC": {
        "Aimovig": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "Fail Aimovig first",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AL audit doc"
        },
        "Emgality": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "Step within class: Emgality/Ajovy",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AL audit doc"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from OptumRx national formulary; verify via payer portal"
        },
        "Zavzpret": {
          "status": "",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Tier 4; PA, ST, QL apply"
        }
      },
      "AL-COM-VIVA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "Fail Aimovig first",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AL audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AL audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "Step within class: Emgality/Ajovy",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AL audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AL audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AL audit doc"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AL audit doc"
        }
      },
      "AL-MA-AETNACARE": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AL audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "Fail Aimovig first",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AL audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AL audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "Step within class: Emgality/Ajovy",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AL audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AL audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AL audit doc"
        }
      },
      "AL-MA-ALBCBS": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AL audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "Fail Aimovig first",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AL audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AL audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "Step within class: Emgality/Ajovy",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AL audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AL audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AL audit doc"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AL audit doc"
        }
      },
      "AL-MA-HUMANA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "Fail Aimovig first",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AL audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AL audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "Step within class: Emgality/Ajovy",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AL audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AL audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AL audit doc"
        }
      },
      "AL-MA-UHC": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "Fail Aimovig first",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AL audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AL audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "Step within class: Emgality/Ajovy",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AL audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AL audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AL audit doc"
        }
      },
      "AL-MAC-PALMETTO": {
        "Botox": {
          "status": "",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "N/A - Medical Benefit",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        }
      },
      "AL-MCD-AMA": {
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "30/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from  national formulary; verify via payer portal | Remapped from AL-MCD-ALMED"
        },
        "Aimovig": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Acentra Health",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "Fail Aimovig first",
          "siteOfCare": "",
          "pbm": "Acentra Health",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Emgality": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "Step within class: Emgality/Ajovy",
          "siteOfCare": "",
          "pbm": "Acentra Health",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Acentra Health",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Acentra Health",
          "confidence": "Audit-Derived",
          "notes": ""
        }
      },
      "AL-PARTB-PALMETTO": {
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AL audit doc"
        }
      },
      "ALL-COM-AETNA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "4/28 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from  national formulary; verify via payer portal"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "4/28 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from  national formulary; verify via payer portal"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from  national formulary; verify via payer portal; SOC default: physician-administered (onabotulinumtoxinA)"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "4/28 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from  national formulary; verify via payer portal"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from  national formulary; verify via payer portal"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from  national formulary; verify via payer portal"
        }
      },
      "ALL-COM-ANTHEM": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "4/28 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from  national formulary; verify via payer portal"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "4/28 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from  national formulary; verify via payer portal"
        },
        "Botox": {
          "status": "Restricted",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "SOC default: physician-administered (onabotulinumtoxinA)"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "4/28 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from  national formulary; verify via payer portal"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from  national formulary; verify via payer portal"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from  national formulary; verify via payer portal"
        }
      },
      "ALL-COM-CENTENE": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "4/28 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from  national formulary; verify via payer portal"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "4/28 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from  national formulary; verify via payer portal"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from  national formulary; verify via payer portal; SOC default: physician-administered (onabotulinumtoxinA)"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "4/28 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from  national formulary; verify via payer portal"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from  national formulary; verify via payer portal"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from  national formulary; verify via payer portal"
        }
      },
      "ALL-COM-CIGNA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "4/28 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from  national formulary; verify via payer portal"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "4/28 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from  national formulary; verify via payer portal"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from  national formulary; verify via payer portal; SOC default: physician-administered (onabotulinumtoxinA)"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "4/28 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from  national formulary; verify via payer portal"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from  national formulary; verify via payer portal"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from  national formulary; verify via payer portal"
        }
      },
      "ALL-COM-CIGNA-CLUSTER": {
        "Emgality (Cluster)": {
          "status": "Restricted",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": ""
        }
      },
      "ALL-COM-HUMANA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "4/28 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from  national formulary; verify via payer portal"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "4/28 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from  national formulary; verify via payer portal"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from  national formulary; verify via payer portal; SOC default: physician-administered (onabotulinumtoxinA)"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "4/28 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from  national formulary; verify via payer portal"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from  national formulary; verify via payer portal"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from  national formulary; verify via payer portal"
        }
      },
      "ALL-COM-KAISER": {
        "Aimovig": {
          "status": "",
          "tier": "Tier 4",
          "qty": "4/28 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ajovy": {
          "status": "",
          "tier": "Tier 4",
          "qty": "4/28 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from  national formulary; verify via payer portal; SOC default: physician-administered (onabotulinumtoxinA)"
        },
        "Emgality": {
          "status": "",
          "tier": "Tier 4",
          "qty": "4/28 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from  national formulary; verify via payer portal"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from  national formulary; verify via payer portal"
        }
      },
      "ALL-COM-MOLINA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "4/28 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from  national formulary; verify via payer portal"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "4/28 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from  national formulary; verify via payer portal"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from  national formulary; verify via payer portal; SOC default: physician-administered (onabotulinumtoxinA)"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "4/28 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from  national formulary; verify via payer portal"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from  national formulary; verify via payer portal"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from  national formulary; verify via payer portal"
        }
      },
      "ALL-COM-UHC-CLUSTER": {
        "Emgality (Cluster)": {
          "status": "Restricted",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": ""
        }
      },
      "ALL-PARTB-CLUSTER": {
        "Emgality (Cluster)": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from  national formulary; verify via payer portal"
        }
      },
      "AR-COM-ABCBS": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from CVS Caremark national formulary; verify via payer portal"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": ""
        }
      },
      "AR-COM-AMBET": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AR audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AR audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AR audit doc"
        },
        "Qulipta": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AR audit doc"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AR audit doc"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AR audit doc"
        }
      },
      "AR-COM-AMBETTER": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Evolent/TurningPoint",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Evolent/TurningPoint",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Evolent/TurningPoint",
          "confidence": "Audit-Derived",
          "notes": ""
        }
      },
      "AR-COM-BCBSAR": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AR audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Prime Therapeutics national formulary; verify via payer portal"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AR audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Prime Therapeutics national formulary; verify via payer portal"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AR audit doc"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AR audit doc"
        }
      },
      "AR-COM-CIGNA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AR audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AR audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AR audit doc"
        },
        "Qulipta": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AR audit doc"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AR audit doc"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AR audit doc"
        },
        "Zavzpret": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Tier 2 (Preferred Brand)"
        }
      },
      "AR-COM-QUAL": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "MedImpact",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "MedImpact",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AR audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "MedImpact",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AR audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "MedImpact",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "MedImpact",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AR audit doc"
        },
        "Qulipta": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "MedImpact",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AR audit doc"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "MedImpact",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AR audit doc"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "MedImpact",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AR audit doc"
        }
      },
      "AR-COM-QUALCHOICE": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AR audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AR audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AR audit doc"
        },
        "Qulipta": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AR audit doc"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AR audit doc"
        }
      },
      "AR-COM-UHC": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AR audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": ""
        }
      },
      "AR-MA-AETNACARE": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AR audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AR audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AR audit doc"
        },
        "Qulipta": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AR audit doc"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AR audit doc"
        }
      },
      "AR-MA-HUMANA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AR audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AR audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AR audit doc"
        },
        "Qulipta": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AR audit doc"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AR audit doc"
        }
      },
      "AR-MA-QUALCHOICE": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "MedImpact",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "MedImpact",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AR audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "MedImpact",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AR audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "MedImpact",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "MedImpact",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AR audit doc"
        },
        "Qulipta": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "MedImpact",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AR audit doc"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "MedImpact",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AR audit doc"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "MedImpact",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AR audit doc"
        }
      },
      "AR-MA-UHC": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AR audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AR audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AR audit doc"
        },
        "Qulipta": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AR audit doc"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AR audit doc"
        }
      },
      "AR-MAC-NOVITAS": {
        "Botox": {
          "status": "",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "N/A - Medical Benefit",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        }
      },
      "AR-MCD-AMBET": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AR audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AR audit doc"
        },
        "Qulipta": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AR audit doc"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AR audit doc"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AR audit doc"
        },
        "Zavzpret": {
          "status": "",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Tier 2 (PA, QL)"
        }
      },
      "AR-MCD-ARDHS": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "State SPBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "State SPBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "State SPBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        }
      },
      "AR-MCD-DHS": {
        "Qulipta": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "30/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AR audit doc | Remapped from AR-MCD-ARMEDIC"
        },
        "Aimovig": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Magellan/Prime",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Magellan/Prime",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Botox": {
          "status": "",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Magellan/Prime",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        },
        "Emgality": {
          "status": "Non-Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Magellan/Prime",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Magellan/Prime",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Magellan/Prime",
          "confidence": "Audit-Derived",
          "notes": ""
        }
      },
      "AR-MCD-ARTOTAL": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AR audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AR audit doc"
        },
        "Qulipta": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AR audit doc"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AR audit doc"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AR audit doc"
        },
        "Zavzpret": {
          "status": "",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Tier 2 (PA, QL)"
        }
      },
      "AR-MCD-EMPOWER": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AR audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AR audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AR audit doc"
        },
        "Qulipta": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AR audit doc"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AR audit doc"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AR audit doc"
        }
      },
      "AR-MCD-QUALCHOICE": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "MedImpact",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "MedImpact",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AR audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "MedImpact",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AR audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "MedImpact",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "MedImpact",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AR audit doc"
        },
        "Qulipta": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "MedImpact",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AR audit doc"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "MedImpact",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AR audit doc"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "MedImpact",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AR audit doc"
        },
        "Zavzpret": {
          "status": "",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Tier 2 (PA, QL)"
        }
      },
      "AR-PARTB-NOVITAS": {
        "Botox": {
          "status": "",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        }
      },
      "AZ-CHIP-MERCYCARE": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AZ audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AZ audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AZ audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AZ audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AZ audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AZ audit doc"
        }
      },
      "AZ-CHIP-MOLINA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AZ audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AZ audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AZ audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AZ audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AZ audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AZ audit doc"
        }
      },
      "AZ-CHIP-UHC": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AZ audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AZ audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AZ audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AZ audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AZ audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AZ audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AZ audit doc"
        }
      },
      "AZ-COM-AETNA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AZ audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AZ audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AZ audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AZ audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AZ audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AZ audit doc"
        }
      },
      "AZ-COM-BCBSAZ": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ajovy": {
          "status": "Excluded",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AZ audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AZ audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "30/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Prime Therapeutics national formulary; verify via payer portal"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AZ audit doc"
        },
        "Emgality (Cluster)": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AZ audit doc | Remapped from AZ-COM-BCBSAZ-CLUSTER (cluster variant)"
        },
        "Zavzpret": {
          "status": "",
          "tier": "Tier 6",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Tier MB (Medical Benefit) or Tier 6 (Specialty), PA required"
        }
      },
      "AZ-COM-CIGNA": {
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AZ audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AZ audit doc"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AZ audit doc"
        },
        "Zavzpret": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Preferred Brand (Tier 2)"
        }
      },
      "AZ-COM-OSCAR": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AZ audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AZ audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AZ audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AZ audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AZ audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AZ audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AZ audit doc"
        }
      },
      "AZ-COM-UHC": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "Fail injectable CGRP first",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ajovy": {
          "status": "Excluded",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "Fail injectable CGRP first",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "Fail injectable CGRP first",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AZ audit doc"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AZ audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AZ audit doc"
        },
        "Zavzpret": {
          "status": "",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Tier 4, ST, PA, and QL required"
        }
      },
      "AZ-MA-AETNACARE": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AZ audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AZ audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AZ audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AZ audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AZ audit doc"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Aetna Medicare 2026: Vyepti (eptinezumab) is now non-preferred on the Part B drug list; requires documented failure of B"
        }
      },
      "AZ-MA-BANNER": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AZ audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AZ audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AZ audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AZ audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AZ audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AZ audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AZ audit doc"
        }
      },
      "AZ-MA-CIGNA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AZ audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AZ audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AZ audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AZ audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AZ audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AZ audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AZ audit doc"
        }
      },
      "AZ-MA-HUMANA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AZ audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AZ audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AZ audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AZ audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AZ audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AZ audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AZ audit doc"
        }
      },
      "AZ-MA-UHC": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AZ audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AZ audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AZ audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AZ audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AZ audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AZ audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AZ audit doc"
        }
      },
      "AZ-MAC-NORIDIAN": {
        "Botox": {
          "status": "",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "N/A - Medical Benefit",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        }
      },
      "AZ-MCD-AETNABETTER": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AZ audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AZ audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AZ audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AZ audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AZ audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AZ audit doc"
        }
      },
      "AZ-MCD-AHCCCS": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AZ audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AZ audit doc"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": ""
        }
      },
      "AZ-MCD-AZCOMPLETE": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AZ audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AZ audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AZ audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AZ audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AZ audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AZ audit doc"
        }
      },
      "AZ-MCD-BANNER": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AZ audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AZ audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AZ audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AZ audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AZ audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AZ audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AZ audit doc"
        }
      },
      "AZ-MCD-CAREFIRST": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AZ audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AZ audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AZ audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AZ audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AZ audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AZ audit doc"
        }
      },
      "AZ-MCD-HEALTHCHOICE": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AZ audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AZ audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AZ audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AZ audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AZ audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AZ audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AZ audit doc"
        }
      },
      "AZ-MCD-MERCYCARE": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AZ audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AZ audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AZ audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AZ audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AZ audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AZ audit doc"
        }
      },
      "AZ-MCD-UHC": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AZ audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AZ audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AZ audit doc"
        }
      },
      "AZ-PARTB-NORIDIAN": {
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from AZ audit doc"
        }
      },
      "CA-CHIP-ANTHEM": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Elevance PBM",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Elevance PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CA audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Elevance PBM",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: physician-administered (onabotulinumtoxinA)"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Elevance PBM",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Elevance PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CA audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Elevance PBM",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Elevance PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CA audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Elevance PBM",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: IV infusion (eptinezumab)"
        }
      },
      "CA-CHIP-HEALTHNET": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Centene PBM",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Centene PBM",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Centene PBM",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: physician-administered (onabotulinumtoxinA)"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Centene PBM",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Centene PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CA audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Centene PBM",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Centene PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CA audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Centene PBM",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: IV infusion (eptinezumab)"
        }
      },
      "CA-CHIP-MOLINA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CA audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: physician-administered (onabotulinumtoxinA)"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CA audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CA audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: IV infusion (eptinezumab)"
        }
      },
      "CA-COM-AETNA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CA audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: physician-administered (onabotulinumtoxinA)"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CA audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CA audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: IV infusion (eptinezumab)"
        }
      },
      "CA-COM-ANTHEMBC": {
        "Aimovig": {
          "status": "Non-Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "Step through preferred CGRP",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "Step through preferred CGRP",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Botox": {
          "status": "Restricted",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "SOC default: physician-administered (onabotulinumtoxinA)"
        },
        "Emgality": {
          "status": "Non-Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "Step through preferred CGRP",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CA audit doc"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CA audit doc"
        }
      },
      "CA-COM-BSCA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "Step through preferred CGRP",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "Step through preferred CGRP",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Prime Therapeutics national formulary; verify via payer portal; SOC default: physician-administered (onabotulinumtoxinA)"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "Step through preferred CGRP",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Prime Therapeutics national formulary; verify via payer portal"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Prime Therapeutics national formulary; verify via payer portal"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Prime Therapeutics national formulary; verify via payer portal; SOC default: IV infusion (eptinezumab)"
        }
      },
      "CA-COM-HNET": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Express Scripts national formulary; verify via payer portal"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CA audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Express Scripts national formulary; verify via payer portal"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CA audit doc"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CA audit doc"
        },
        "Vyepti": {
          "status": "Excluded",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Excluded"
        },
        "Zavzpret": {
          "status": "Excluded",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Excluded"
        }
      },
      "CA-COM-KAISER": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Kaiser Permanente (Internal)/MedImpact",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Kaiser Permanente (Internal)/MedImpact",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Kaiser Permanente (Internal)/MedImpact",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Kaiser Permanente (Internal)/MedImpact national formulary; verify via payer portal; SOC default: physician-administered (onabotulinumtoxinA)"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Kaiser Permanente (Internal)/MedImpact",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Nurtec ODT": {
          "status": "",
          "tier": "Tier 4",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Kaiser Permanente (Internal)/MedImpact",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ubrelvy": {
          "status": "",
          "tier": "Tier 4",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Kaiser Permanente (Internal)/MedImpact",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Kaiser Permanente (Internal)/MedImpact",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Kaiser Permanente (Internal)/MedImpact national formulary; verify via payer portal; SOC default: IV infusion (eptinezumab)"
        }
      },
      "CA-COM-UHC": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CA audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: physician-administered (onabotulinumtoxinA)"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CA audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CA audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: IV infusion (eptinezumab)"
        },
        "Zavzpret": {
          "status": "Covered",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Covered (OptumRx Premium Formulary)"
        }
      },
      "CA-MA-AETNACARE": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CA audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: physician-administered (onabotulinumtoxinA)"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CA audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CA audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: IV infusion (eptinezumab)"
        }
      },
      "CA-MA-ALIGN": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CA audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: physician-administered (onabotulinumtoxinA)"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CA audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CA audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: IV infusion (eptinezumab)"
        }
      },
      "CA-MA-CABCBS": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CA audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: physician-administered (onabotulinumtoxinA)"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CA audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CA audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: IV infusion (eptinezumab)"
        }
      },
      "CA-MA-HUMANA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CA audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: physician-administered (onabotulinumtoxinA)"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CA audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CA audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: IV infusion (eptinezumab)"
        }
      },
      "CA-MA-KAISER": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Kaiser Permanente (Internal)/MedImpact",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Kaiser Permanente (Internal)/MedImpact",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CA audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Kaiser Permanente (Internal)/MedImpact",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: physician-administered (onabotulinumtoxinA)"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Kaiser Permanente (Internal)/MedImpact",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Kaiser Permanente (Internal)/MedImpact",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CA audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Kaiser Permanente (Internal)/MedImpact",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Kaiser Permanente (Internal)/MedImpact",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CA audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Kaiser Permanente (Internal)/MedImpact",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: IV infusion (eptinezumab)"
        }
      },
      "CA-MA-SCANHEALTH": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CA audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: physician-administered (onabotulinumtoxinA)"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CA audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CA audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: IV infusion (eptinezumab)"
        }
      },
      "CA-MA-UHC": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CA audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: physician-administered (onabotulinumtoxinA)"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CA audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CA audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: IV infusion (eptinezumab)"
        }
      },
      "CA-MAC-NORIDIAN": {
        "Botox": {
          "status": "",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "N/A - Medical Benefit",
          "confidence": "Gap-Manual-Review",
          "notes": "No audit data or PBM match; PBM=N/A - Medical Benefit; requires manual verification; SOC default: physician-administered (onabotulinumtoxinA)"
        }
      },
      "CA-MCD-ANTHEM": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CA audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: physician-administered (onabotulinumtoxinA)"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CA audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CA audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: IV infusion (eptinezumab)"
        }
      },
      "CA-MCD-CALOPTIMA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CA audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: physician-administered (onabotulinumtoxinA)"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CA audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CA audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: IV infusion (eptinezumab)"
        }
      },
      "CA-MCD-CENTENE": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: physician-administered (onabotulinumtoxinA)"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CA audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CA audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: IV infusion (eptinezumab)"
        }
      },
      "CA-MCD-INLANDHEALTH": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CA audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: physician-administered (onabotulinumtoxinA)"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CA audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CA audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: IV infusion (eptinezumab)"
        }
      },
      "CA-MCD-LACARE": {
        "Botox": {
          "status": "",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "State SPBM",
          "confidence": "Gap-Manual-Review",
          "notes": "No audit data or PBM match; PBM=State SPBM; requires manual verification; SOC default: physician-administered (onabotulinumtoxinA)"
        },
        "Emgality (Cluster)": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from  national formulary; verify via payer portal | Remapped from CA-MCD-LACARE-CLUSTER (cluster variant)"
        }
      },
      "CA-MCD-LACAREHEALTH": {
        "Vyepti": {
          "status": "",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Navitus Health Solutions",
          "confidence": "Gap-Manual-Review",
          "notes": "No audit data or PBM match; PBM=Navitus Health Solutions; requires manual verification; SOC default: IV infusion (eptinezumab)"
        }
      },
      "CA-MCD-MEDICALRX": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Magellan Rx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        },
        "Ajovy": {
          "status": "Covered",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Magellan Rx",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: CDL covered with LR; restricted to use for the preventative treatment of migraine only"
        },
        "Emgality": {
          "status": "Covered",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Magellan Rx",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: CDL covered with LR; restricted to use for the preventative treatment of migraine only"
        },
        "Nurtec ODT": {
          "status": "Covered",
          "tier": "",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Magellan Rx",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: CDL covered with LR and QL; restricted to acute treatment of migraine headache only"
        },
        "Ubrelvy": {
          "status": "Restricted",
          "tier": "",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Magellan Rx",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Vyepti": {
          "status": "",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Magellan Rx",
          "confidence": "Gap-Manual-Review",
          "notes": "No audit data or PBM match; PBM=Magellan Rx; requires manual verification; SOC default: IV infusion (eptinezumab)"
        },
        "Emgality (Cluster)": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from  national formulary; verify via payer portal | Remapped from CA-MCD-MEDICALRX-CLUSTER (cluster variant)"
        }
      },
      "CA-MCD-MOLINA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CA audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: physician-administered (onabotulinumtoxinA)"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CA audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CA audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: IV infusion (eptinezumab)"
        }
      },
      "CA-MCD-PARTHEALTH": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "MedImpact",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "MedImpact",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CA audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "MedImpact",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: physician-administered (onabotulinumtoxinA)"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "MedImpact",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "MedImpact",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CA audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "MedImpact",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "MedImpact",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CA audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "MedImpact",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: IV infusion (eptinezumab)"
        }
      },
      "CA-MCD-PROMISEBS": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CA audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: physician-administered (onabotulinumtoxinA)"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CA audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CA audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: IV infusion (eptinezumab)"
        }
      },
      "CA-PARTB-NORIDIAN": {
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from  national formulary; verify via payer portal"
        }
      },
      "CO-COM-AETNA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CO audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CO audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CO audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CO audit doc"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CO audit doc"
        }
      },
      "CO-COM-CIGNA": {
        "Aimovig": {
          "status": "Non-Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Botox": {
          "status": "Restricted",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Emgality": {
          "status": "Non-Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CO audit doc"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Zavzpret": {
          "status": "",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Tier 2 (PA Required)"
        }
      },
      "CO-COM-ELEV": {
        "Aimovig": {
          "status": "Non-Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CO audit doc"
        },
        "Emgality": {
          "status": "Non-Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CO audit doc"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "30/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from  national formulary; verify via payer portal | Remapped from CO-COM-VARIOUS"
        }
      },
      "CO-COM-FRIDAY": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CO audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CO audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CO audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CO audit doc"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CO audit doc"
        }
      },
      "CO-COM-KAISER": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Kaiser Permanente (Internal)/MedImpact",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Kaiser Permanente (Internal)/MedImpact national formulary; verify via payer portal"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Kaiser Permanente (Internal)/MedImpact",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CO audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Kaiser Permanente (Internal)/MedImpact",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Kaiser Permanente (Internal)/MedImpact national formulary; verify via payer portal"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Kaiser Permanente (Internal)/MedImpact",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CO audit doc"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Kaiser Permanente (Internal)/MedImpact",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CO audit doc"
        }
      },
      "CO-COM-UHC": {
        "Aimovig": {
          "status": "Non-Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "Fail Aimovig first",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "Fail Aimovig first",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Botox": {
          "status": "Restricted",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Emgality": {
          "status": "Non-Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "Fail Aimovig first",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "12/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CO audit doc"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "12/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CO audit doc"
        }
      },
      "CO-MA-AETNACARE": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CO audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CO audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CO audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CO audit doc"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CO audit doc"
        }
      },
      "CO-MA-ELEV": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CO audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CO audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CO audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CO audit doc"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CO audit doc"
        }
      },
      "CO-MA-HUMANA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CO audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CO audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CO audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CO audit doc"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CO audit doc"
        }
      },
      "CO-MA-KAISER": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Kaiser Permanente (Internal)/MedImpact",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Kaiser Permanente (Internal)/MedImpact",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CO audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Kaiser Permanente (Internal)/MedImpact",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CO audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Kaiser Permanente (Internal)/MedImpact",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Kaiser Permanente (Internal)/MedImpact",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CO audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Kaiser Permanente (Internal)/MedImpact",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Kaiser Permanente (Internal)/MedImpact",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CO audit doc"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Kaiser Permanente (Internal)/MedImpact",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CO audit doc"
        }
      },
      "CO-MA-UHC": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CO audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CO audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CO audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CO audit doc"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CO audit doc"
        }
      },
      "CO-MAC-NORIDIAN": {
        "Botox": {
          "status": "",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "N/A - Medical Benefit",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        }
      },
      "CO-MCD-COACCESS": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CO audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CO audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CO audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CO audit doc"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CO audit doc"
        }
      },
      "CO-MCD-COMEDICAID": {
        "Emgality (Cluster)": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from  national formulary; verify via payer portal | Remapped from CO-MCD-COMEDICAID-CLUSTER (cluster variant)"
        }
      },
      "CO-MCD-DENVERHEALTH": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CO audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CO audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CO audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CO audit doc"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CO audit doc"
        }
      },
      "CO-MCD-FRIDAY": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CO audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CO audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CO audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CO audit doc"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CO audit doc"
        }
      },
      "CO-MCD-HEALTHFIRST": {
        "Aimovig": {
          "status": "Non-Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Conduent",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Conduent",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Preferred"
        },
        "Botox": {
          "status": "",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Conduent",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        },
        "Emgality": {
          "status": "Non-Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Conduent",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Conduent",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Conduent",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Zavzpret": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Non-Preferred"
        }
      },
      "CO-MCD-ROCKYMT": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CO audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CO audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CO audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CO audit doc"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CO audit doc"
        }
      },
      "CO-PARTB-NOVITAS": {
        "Botox": {
          "status": "",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "N/A - Medicare",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "N/A - Medicare",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        }
      },
      "CT-COM-CTCARE": {
        "Qulipta": {
          "status": "Preferred",
          "tier": "Tier 1",
          "qty": "30/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CT audit doc | Remapped from CT-ACA-EXCHANGE"
        },
        "Aimovig": {
          "status": "Non-Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Emgality": {
          "status": "Non-Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 1",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CT audit doc"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 1",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CT audit doc"
        }
      },
      "CT-CHIP-ANTHEM": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 1",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Elevance PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CT audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 1",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Elevance PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CT audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Elevance PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CT audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Elevance PBM",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 1",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Elevance PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CT audit doc"
        },
        "Qulipta": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Elevance PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CT audit doc"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 1",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Elevance PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CT audit doc"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Elevance PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CT audit doc"
        }
      },
      "CT-COM-AETNA": {
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 1",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CT audit doc"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 1",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CT audit doc"
        },
        "Botox": {
          "status": "Excluded",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Excluded (Preferred alternatives: Ajovy, Daxxify, Dysport, Emgality, Qulipta, Xeomin)"
        },
        "Aimovig": {
          "status": "Excluded",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Excluded (Preferred alternatives: Ajovy, Emgality, Qulipta)"
        }
      },
      "CT-COM-ANTHEM": {
        "Aimovig": {
          "status": "Non-Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Elevance PBM",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Elevance PBM",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Emgality": {
          "status": "Non-Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Elevance PBM",
          "confidence": "Audit-Derived",
          "notes": ""
        }
      },
      "CT-COM-CIGNA": {
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 1",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CT audit doc"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 1",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CT audit doc"
        },
        "Zavzpret": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: status=Preferred, tier=Tier 2, paRequired=True"
        }
      },
      "CT-COM-CONNECTICARE": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Molina PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Molina PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Molina PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        }
      },
      "CT-COM-ELEV": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from IngenioRx (Carelon) national formulary; verify via payer portal"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CT audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from IngenioRx (Carelon) national formulary; verify via payer portal"
        }
      },
      "CT-COM-UHC": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CT audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CT audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 1",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CT audit doc"
        },
        "Qulipta": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CT audit doc"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 1",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CT audit doc"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CT audit doc"
        }
      },
      "CT-MA-AETNACARE": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CT audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CT audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 1",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CT audit doc"
        },
        "Qulipta": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CT audit doc"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 1",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CT audit doc"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CT audit doc"
        }
      },
      "CT-MA-CIGNA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CT audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CT audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 1",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CT audit doc"
        },
        "Qulipta": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CT audit doc"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 1",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CT audit doc"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CT audit doc"
        }
      },
      "CT-MA-ELEV": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CT audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CT audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 1",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CT audit doc"
        },
        "Qulipta": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CT audit doc"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 1",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CT audit doc"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CT audit doc"
        }
      },
      "CT-MA-HUMANA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CT audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CT audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 1",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CT audit doc"
        },
        "Qulipta": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CT audit doc"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 1",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CT audit doc"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CT audit doc"
        }
      },
      "CT-MA-UHC": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CT audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CT audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 1",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CT audit doc"
        },
        "Qulipta": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CT audit doc"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 1",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CT audit doc"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CT audit doc"
        }
      },
      "CT-MCD-HUSKY": {
        "Aimovig": {
          "status": "Non-Preferred",
          "tier": "Tier 1",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Gainwell Technologies",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 1",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Gainwell Technologies",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Emgality": {
          "status": "Non-Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Gainwell Technologies",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 1",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Gainwell Technologies",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 1",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Gainwell Technologies",
          "confidence": "Audit-Derived",
          "notes": ""
        }
      },
      "CT-PARTB-NGS": {
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from CT audit doc"
        }
      },
      "DC-COM-AETNA": {
        "Aimovig": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: physician-administered (onabotulinumtoxinA)"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: IV infusion (eptinezumab)"
        }
      },
      "DC-COM-CAREBCBS": {
        "Aimovig": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: physician-administered (onabotulinumtoxinA)"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: IV infusion (eptinezumab)"
        }
      },
      "DC-COM-CIGNA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: physician-administered (onabotulinumtoxinA)"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: IV infusion (eptinezumab)"
        }
      },
      "DC-COM-KAISER": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Kaiser Permanente (Internal)/MedImpact",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Kaiser Permanente (Internal)/MedImpact",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Kaiser Permanente (Internal)/MedImpact",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: physician-administered (onabotulinumtoxinA)"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Kaiser Permanente (Internal)/MedImpact",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Kaiser Permanente (Internal)/MedImpact",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Kaiser Permanente (Internal)/MedImpact",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Kaiser Permanente (Internal)/MedImpact",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Kaiser Permanente (Internal)/MedImpact",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: IV infusion (eptinezumab)"
        }
      },
      "DC-COM-UHC": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: physician-administered (onabotulinumtoxinA)"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: IV infusion (eptinezumab)"
        }
      },
      "DC-MA-AETNACARE": {
        "Aimovig": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: physician-administered (onabotulinumtoxinA)"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Vyepti designated non-preferred on Medicare Part B preferred drug list. Coverage now requires documented inadequate resp"
        }
      },
      "DC-MA-CAREBCBS": {
        "Aimovig": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: physician-administered (onabotulinumtoxinA)"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: IV infusion (eptinezumab)"
        }
      },
      "DC-MA-HUMANA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: physician-administered (onabotulinumtoxinA)"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: IV infusion (eptinezumab)"
        }
      },
      "DC-MA-UHC": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: physician-administered (onabotulinumtoxinA)"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: IV infusion (eptinezumab)"
        }
      },
      "DC-MCD-AMERIGROUP": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: physician-administered (onabotulinumtoxinA)"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: IV infusion (eptinezumab)"
        }
      },
      "DC-MCD-AMERIHEALTH": {
        "Aimovig": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: physician-administered (onabotulinumtoxinA)"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: IV infusion (eptinezumab)"
        }
      },
      "DC-MCD-CAREFIRST": {
        "Aimovig": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: physician-administered (onabotulinumtoxinA)"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: IV infusion (eptinezumab)"
        }
      },
      "DC-MCD-MEDSTARFAMILY": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: physician-administered (onabotulinumtoxinA)"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: IV infusion (eptinezumab)"
        }
      },
      "DC-MCD-TRUSTEDHEALTH": {
        "Aimovig": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: physician-administered (onabotulinumtoxinA)"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: IV infusion (eptinezumab)"
        }
      },
      "DC-MCD-UHC": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: physician-administered (onabotulinumtoxinA)"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: IV infusion (eptinezumab)"
        }
      },
      "DE-COM-AETNA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from DE audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from DE audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from DE audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from DE audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from DE audit doc"
        }
      },
      "DE-COM-CIGNA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Express Scripts national formulary; verify via payer portal"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from DE audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Express Scripts national formulary; verify via payer portal"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from DE audit doc"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from DE audit doc"
        },
        "Zavzpret": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Tier 2 (Preferred Brand - PA Required)"
        }
      },
      "DE-COM-HIGH": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from DE audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from DE audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from DE audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from DE audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from DE audit doc"
        }
      },
      "DE-COM-HIGHBCBS": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Express Scripts national formulary; verify via payer portal"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from DE audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from DE audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Express Scripts national formulary; verify via payer portal"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from DE audit doc"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from DE audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "1/90 days",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Express Scripts national formulary; verify via payer portal"
        },
        "Emgality (Cluster)": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from  national formulary; verify via payer portal | Remapped from DE-COM-HIGHBCBS-CLUSTER (cluster variant)"
        }
      },
      "DE-COM-HIGHMARK": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Highmark PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Highmark PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        },
        "Botox": {
          "status": "",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Highmark PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Highmark PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        },
        "Nurtec ODT": {
          "status": "",
          "tier": "",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Highmark PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        },
        "Ubrelvy": {
          "status": "",
          "tier": "",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Highmark PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        },
        "Vyepti": {
          "status": "",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Highmark PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        }
      },
      "DE-COM-UHC": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from DE audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from DE audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from DE audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from DE audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from DE audit doc"
        },
        "Zavzpret": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Tier 4 (Non-Preferred - PA, ST, QL Required)"
        }
      },
      "DE-MA-AETNACARE": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from DE audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from DE audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from DE audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from DE audit doc"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Vyepti designated non-preferred on Aetna Medicare Part B preferred drug list. Coverage now requires documented inadequat"
        }
      },
      "DE-MA-HIGHMARK": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from DE audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from DE audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from DE audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from DE audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from DE audit doc"
        }
      },
      "DE-MA-HUMANA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from DE audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from DE audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from DE audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from DE audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from DE audit doc"
        }
      },
      "DE-MA-UHC": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from DE audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from DE audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from DE audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from DE audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from DE audit doc"
        }
      },
      "DE-MAC-NOVITAS": {
        "Botox": {
          "status": "",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "N/A - Medical Benefit",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        }
      },
      "DE-MCD-AMERIHEALTH": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from DE audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": ""
        }
      },
      "DE-MCD-DEFIRST": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Centene PBM",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Centene PBM national formulary; verify via payer portal"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Centene PBM",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Centene PBM national formulary; verify via payer portal"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Centene PBM",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Centene PBM national formulary; verify via payer portal"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "30/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from  national formulary; verify via payer portal | Remapped from DE-MCD-DELAWARE1ST"
        }
      },
      "DE-MCD-DELFIRST": {
        "Nurtec ODT": {
          "status": "",
          "tier": "",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "State SPBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        },
        "Ubrelvy": {
          "status": "",
          "tier": "",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "State SPBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        }
      },
      "DE-MCD-HIGHMARK": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from DE audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from DE audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from DE audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from DE audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from DE audit doc"
        }
      },
      "DE-PARTB-NOVITAS": {
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from DE audit doc"
        }
      },
      "FL-CHIP-AETNA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from FL audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from FL audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from FL audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from FL audit doc"
        }
      },
      "FL-CHIP-MOLINA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from FL audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from FL audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from FL audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from FL audit doc"
        }
      },
      "FL-CHIP-SIMPLY": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Elevance PBM",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Elevance PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from FL audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Elevance PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from FL audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Elevance PBM",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Elevance PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from FL audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Elevance PBM",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Elevance PBM",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Elevance PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from FL audit doc"
        }
      },
      "FL-CHIP-SUNSHINE": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Centene PBM",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Centene PBM",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Centene PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from FL audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Centene PBM",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Centene PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from FL audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Centene PBM",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Centene PBM",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Centene PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from FL audit doc"
        }
      },
      "FL-COM-AETNA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from FL audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from FL audit doc"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from CVS Caremark national formulary; verify via payer portal"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from CVS Caremark national formulary; verify via payer portal"
        }
      },
      "FL-COM-AMBET": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Express Scripts national formulary; verify via payer portal"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from FL audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Express Scripts national formulary; verify via payer portal"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from FL audit doc"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Express Scripts national formulary; verify via payer portal"
        }
      },
      "FL-COM-CIGNA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from FL audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from FL audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from FL audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from FL audit doc"
        }
      },
      "FL-COM-FLBLUECOM": {
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "30/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from  national formulary; verify via payer portal | Remapped from FL-COM-FLBLUE"
        },
        "Aimovig": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "Step through preferred CGRP",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "Step through preferred CGRP",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "Step through preferred CGRP",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Nurtec ODT": {
          "status": "",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ubrelvy": {
          "status": "",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Prime Therapeutics national formulary; verify via payer portal"
        }
      },
      "FL-COM-HUMANA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from FL audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from FL audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from FL audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from FL audit doc"
        }
      },
      "FL-COM-UHC": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from FL audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from OptumRx national formulary; verify via payer portal"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from OptumRx national formulary; verify via payer portal"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from OptumRx national formulary; verify via payer portal"
        },
        "Zavzpret": {
          "status": "",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Added to Tier 4 with strict PA, ST, and QL restrictions."
        }
      },
      "FL-MA-AETNACARE": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from FL audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from FL audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from FL audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Vyepti designated non-preferred on Aetna Medicare Part B preferred drug list. Coverage now requires documented inadequat"
        }
      },
      "FL-MA-CIGNA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from FL audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from FL audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from FL audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from FL audit doc"
        }
      },
      "FL-MA-CLOVER": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from FL audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from FL audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from FL audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from FL audit doc"
        }
      },
      "FL-MA-DEVOTED": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from FL audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from FL audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from FL audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from FL audit doc"
        }
      },
      "FL-MA-HUMANA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from FL audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from FL audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from FL audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from FL audit doc"
        }
      },
      "FL-MA-UHC": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from FL audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from FL audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from FL audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from FL audit doc"
        }
      },
      "FL-MAC-FCSO": {
        "Botox": {
          "status": "",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "N/A - Medical Benefit",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        }
      },
      "FL-MCD-COMMCARE": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from FL audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from FL audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from FL audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from FL audit doc"
        }
      },
      "FL-MCD-FLCOMMCARE": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from FL audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from FL audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from FL audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from FL audit doc"
        }
      },
      "FL-MCD-FLMEDICAID": {
        "Emgality (Cluster)": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from  national formulary; verify via payer portal | Remapped from FL-MCD-FLMEDICAID-CLUSTER (cluster variant)"
        }
      },
      "FL-MCD-HUMANA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from FL audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from FL audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from FL audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from FL audit doc"
        }
      },
      "FL-MCD-PRESTIGE": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from FL audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from FL audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from FL audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from FL audit doc"
        }
      },
      "FL-MCD-SIMPLYHEALTH": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from FL audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from FL audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from FL audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from FL audit doc"
        }
      },
      "FL-MCD-SUNSHINE": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from FL audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Envolve Pharmacy Solutions national formulary; verify via payer portal"
        }
      },
      "FL-PARTB-FCSO": {
        "Botox": {
          "status": "",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "N/A - Medicare",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        },
        "Vyepti": {
          "status": "",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "N/A - Medicare",
          "confidence": "Gap-Manual-Review",
          "notes": "No audit data or PBM match; PBM=N/A - Medicare; requires manual verification"
        }
      },
      "GA-CHIP-AMERIGROUP": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Elevance PBM",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Elevance PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from GA audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Elevance PBM",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: physician-administered (onabotulinumtoxinA)"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Elevance PBM",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Elevance PBM",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Elevance PBM",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Elevance PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from GA audit doc"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "Fail Aimovig first",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Elevance PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from GA audit doc; SOC default: IV infusion (eptinezumab)"
        }
      },
      "GA-CHIP-PEACHSTATE": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Centene PBM",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Centene PBM",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Centene PBM",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: physician-administered (onabotulinumtoxinA)"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Centene PBM",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Centene PBM",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Centene PBM",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Centene PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from GA audit doc"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "Fail Aimovig first",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Centene PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from GA audit doc; SOC default: IV infusion (eptinezumab)"
        }
      },
      "GA-COM-AETNA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from GA audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: physician-administered (onabotulinumtoxinA)"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from GA audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "Fail Aimovig first",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from GA audit doc; SOC default: IV infusion (eptinezumab)"
        }
      },
      "GA-COM-AMBET": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Express Scripts national formulary; verify via payer portal"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from GA audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Express Scripts national formulary; verify via payer portal"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Express Scripts national formulary; verify via payer portal"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from GA audit doc"
        }
      },
      "GA-COM-CIGNA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from GA audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: physician-administered (onabotulinumtoxinA)"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from GA audit doc"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "Fail Aimovig first",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from GA audit doc; SOC default: IV infusion (eptinezumab)"
        },
        "Zavzpret": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Tier 2 (Preferred Brand)"
        }
      },
      "GA-COM-ELEV": {
        "Aimovig": {
          "status": "Non-Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from IngenioRx (Carelon) national formulary; verify via payer portal; SOC default: physician-administered (onabotulinumtoxinA)"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Vyepti": {
          "status": "Restricted",
          "tier": "",
          "qty": "",
          "stepInClass": "Fail Aimovig first",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "30/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from  national formulary; verify via payer portal | Remapped from GA-COM-VARIOUS"
        }
      },
      "GA-COM-KAISER": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Kaiser Permanente (Internal)/MedImpact",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Kaiser Permanente (Internal)/MedImpact",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from GA audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Kaiser Permanente (Internal)/MedImpact",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: physician-administered (onabotulinumtoxinA)"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Kaiser Permanente (Internal)/MedImpact",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Kaiser Permanente (Internal)/MedImpact",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Kaiser Permanente (Internal)/MedImpact",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Kaiser Permanente (Internal)/MedImpact",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from GA audit doc"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "Fail Aimovig first",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Kaiser Permanente (Internal)/MedImpact",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from GA audit doc; SOC default: IV infusion (eptinezumab)"
        },
        "Zavzpret": {
          "status": "",
          "tier": "Tier 5",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Tier 5 (Specialty)"
        }
      },
      "GA-COM-UHC": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from OptumRx national formulary; verify via payer portal; SOC default: physician-administered (onabotulinumtoxinA)"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from GA audit doc"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from OptumRx national formulary; verify via payer portal"
        },
        "Zavzpret": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from OptumRx national formulary; verify via payer portal"
        }
      },
      "GA-MA-AETNACARE": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from GA audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: physician-administered (onabotulinumtoxinA)"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from GA audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "Fail Aimovig first",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from GA audit doc; SOC default: IV infusion (eptinezumab)"
        }
      },
      "GA-MA-CIGNA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from GA audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: physician-administered (onabotulinumtoxinA)"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from GA audit doc"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "Fail Aimovig first",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from GA audit doc; SOC default: IV infusion (eptinezumab)"
        }
      },
      "GA-MA-ELEV": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from GA audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: physician-administered (onabotulinumtoxinA)"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from GA audit doc"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "Fail Aimovig first",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from GA audit doc; SOC default: IV infusion (eptinezumab)"
        }
      },
      "GA-MA-HUMANA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from GA audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: physician-administered (onabotulinumtoxinA)"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "Fail Aimovig first",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from GA audit doc; SOC default: IV infusion (eptinezumab)"
        }
      },
      "GA-MA-UHC": {
        "Vyepti": {
          "status": "Restricted",
          "tier": "",
          "qty": "",
          "stepInClass": "Fail SC CGRP before Vyepti",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": ""
        }
      },
      "GA-MAC-PALMETTO": {
        "Botox": {
          "status": "",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "N/A - Medical Benefit",
          "confidence": "Gap-Manual-Review",
          "notes": "No audit data or PBM match; PBM=N/A - Medical Benefit; requires manual verification"
        }
      },
      "GA-MCD-AMERIGROUP": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from GA audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: physician-administered (onabotulinumtoxinA)"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from GA audit doc"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "Fail Aimovig first",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from GA audit doc; SOC default: IV infusion (eptinezumab)"
        }
      },
      "GA-MCD-CARESOURCE": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from GA audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: physician-administered (onabotulinumtoxinA)"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from GA audit doc"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "Fail Aimovig first",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from GA audit doc; SOC default: IV infusion (eptinezumab)"
        }
      },
      "GA-MCD-DCH": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx (Administrative)",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx (Administrative)",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "OptumRx (Administrative)",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from OptumRx (Administrative) national formulary; verify via payer portal; SOC default: physician-administered (onabotulinumtoxinA)"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx (Administrative)",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx (Administrative)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from GA audit doc"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx (Administrative)",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "Step through preferred CGRP",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx (Administrative)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from GA audit doc"
        }
      },
      "GA-MCD-PEACHSTATE": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Envolve Pharmacy Solutions national formulary; verify via payer portal"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Envolve Pharmacy Solutions national formulary; verify via payer portal"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Envolve Pharmacy Solutions national formulary; verify via payer portal"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Envolve Pharmacy Solutions national formulary; verify via payer portal"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from GA audit doc"
        }
      },
      "GA-MCD-WELLCARE": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: physician-administered (onabotulinumtoxinA)"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from GA audit doc"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "Fail Aimovig first",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from GA audit doc; SOC default: IV infusion (eptinezumab)"
        }
      },
      "GA-PARTB-PALMETTO": {
        "Vyepti": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "Fail Aimovig first",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "N/A - Medicare",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        }
      },
      "HI-CHIP-HMSA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from HI audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from HI audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from HI audit doc"
        }
      },
      "HI-COM-HMSA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from OptumRx national formulary; verify via payer portal"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from OptumRx national formulary; verify via payer portal"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from HI audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from OptumRx national formulary; verify via payer portal"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from OptumRx national formulary; verify via payer portal"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "30/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from OptumRx national formulary; verify via payer portal"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from OptumRx national formulary; verify via payer portal"
        },
        "Emgality (Cluster)": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from  national formulary; verify via payer portal | Remapped from HI-COM-HMSA-CLUSTER (cluster variant)"
        }
      },
      "HI-COM-KAISER": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Kaiser Permanente (Internal)/MedImpact",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ajovy": {
          "status": "",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Kaiser Permanente (Internal)/MedImpact",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Kaiser Permanente (Internal)/MedImpact",
          "confidence": "Audit-Derived",
          "notes": ""
        }
      },
      "HI-COM-UHC": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from HI audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from HI audit doc"
        }
      },
      "HI-MA-ALOHA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from HI audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from HI audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Aetna Medicare Advantage national policy applies via CVS Caremark PBM infrastructure: Vyepti (eptinezumab) is non-prefer"
        }
      },
      "HI-MA-HMSA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from HI audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: HMSA Medicare Advantage (OptumRx) aligns with national UHC/OptumRx CGRP step therapy frameworks. Vyepti remains subject "
        }
      },
      "HI-MA-HUMANA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from HI audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from HI audit doc"
        }
      },
      "HI-MA-KAISER": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Kaiser Permanente (Internal)/MedImpact",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Kaiser Permanente (Internal)/MedImpact",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Kaiser Permanente (Internal)/MedImpact",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from HI audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Kaiser Permanente (Internal)/MedImpact",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Kaiser Permanente (Internal)/MedImpact",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Kaiser Permanente (Internal)/MedImpact",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Kaiser Permanente (Internal)/MedImpact",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Kaiser Permanente (Internal)/MedImpact",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from HI audit doc"
        }
      },
      "HI-MA-UHC": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from HI audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from HI audit doc"
        }
      },
      "HI-MAC-NORIDIAN": {
        "Botox": {
          "status": "",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "N/A - Medical Benefit",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        }
      },
      "HI-MCD-ALOHA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from HI audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from HI audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from HI audit doc"
        }
      },
      "HI-MCD-ALOHACARE": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "AlohaCare PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        },
        "Ajovy": {
          "status": "",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "AlohaCare PBM",
          "confidence": "Gap-Manual-Review",
          "notes": "No audit data or PBM match; PBM=AlohaCare PBM; requires manual verification"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "AlohaCare PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        }
      },
      "HI-MCD-HMSA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from HI audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from HI audit doc"
        }
      },
      "HI-MCD-OHANA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from HI audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from HI audit doc"
        }
      },
      "HI-MCD-UHC": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from OptumRx national formulary; verify via payer portal"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from OptumRx national formulary; verify via payer portal"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from OptumRx national formulary; verify via payer portal"
        }
      },
      "HI-PARTB-NORIDIAN": {
        "Botox": {
          "status": "",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        }
      },
      "IA-CHIP-AMERIGROUP": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Elevance PBM",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Elevance PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IA audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "28/30 days",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Elevance PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IA audit doc; SOC default: physician-administered (onabotulinumtoxinA)"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Elevance PBM",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "15/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Elevance PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IA audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Elevance PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IA audit doc"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Elevance PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IA audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Elevance PBM",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: IV infusion (eptinezumab)"
        }
      },
      "IA-CHIP-MOLINA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IA audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "28/30 days",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IA audit doc; SOC default: physician-administered (onabotulinumtoxinA)"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "15/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IA audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IA audit doc"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IA audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: IV infusion (eptinezumab)"
        }
      },
      "IA-COM-AETNA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IA audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from CVS Caremark national formulary; verify via payer portal"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from CVS Caremark national formulary; verify via payer portal"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Preferred"
        }
      },
      "IA-COM-MEDICA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IA audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "28/30 days",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IA audit doc; SOC default: physician-administered (onabotulinumtoxinA)"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "15/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IA audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IA audit doc"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IA audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: IV infusion (eptinezumab)"
        }
      },
      "IA-COM-UHC": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from OptumRx national formulary; verify via payer portal"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IA audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from OptumRx national formulary; verify via payer portal"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "15/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IA audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 2",
          "qty": "30/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IA audit doc"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IA audit doc"
        },
        "Zavzpret": {
          "status": "Covered",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Covered, Tier 4 (Requires PA, ST, QL)"
        }
      },
      "IA-COM-WELLBCBS": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IA audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from CVS Caremark national formulary; verify via payer portal"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "28/30 days",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IA audit doc; SOC default: physician-administered (onabotulinumtoxinA)"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from CVS Caremark national formulary; verify via payer portal"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "15/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IA audit doc"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IA audit doc"
        }
      },
      "IA-COM-WELLMARK": {
        "Aimovig": {
          "status": "Non-Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "28/30 days",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IA audit doc; SOC default: physician-administered (onabotulinumtoxinA)"
        },
        "Emgality": {
          "status": "Non-Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "15/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IA audit doc"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IA audit doc"
        }
      },
      "IA-MA-AETNACARE": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IA audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "28/30 days",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IA audit doc; SOC default: physician-administered (onabotulinumtoxinA)"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "15/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IA audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IA audit doc"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IA audit doc"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Aetna Medicare 2026 national policy: Vyepti (eptinezumab) is now non-preferred on the Part B drug list. Requires documen"
        }
      },
      "IA-MA-HUMANA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IA audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "28/30 days",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IA audit doc; SOC default: physician-administered (onabotulinumtoxinA)"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "15/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IA audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IA audit doc"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IA audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: IV infusion (eptinezumab)"
        }
      },
      "IA-MA-UHC": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IA audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "28/30 days",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IA audit doc; SOC default: physician-administered (onabotulinumtoxinA)"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "15/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IA audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IA audit doc"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IA audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: IV infusion (eptinezumab)"
        }
      },
      "IA-MA-WELLMARKBCBS": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IA audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "28/30 days",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IA audit doc; SOC default: physician-administered (onabotulinumtoxinA)"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "15/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IA audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IA audit doc"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IA audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: IV infusion (eptinezumab)"
        }
      },
      "IA-MCD-IAHHS": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "State SPBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "State SPBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "State SPBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        }
      },
      "IA-MCD-ITC": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Centene PBM",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Centene PBM national formulary; verify via payer portal"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Centene PBM",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Centene PBM national formulary; verify via payer portal"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Centene PBM",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Centene PBM national formulary; verify via payer portal"
        }
      },
      "IA-MCD-MOLINA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IA audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "28/30 days",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IA audit doc; SOC default: physician-administered (onabotulinumtoxinA)"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "15/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IA audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IA audit doc"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IA audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: IV infusion (eptinezumab)"
        }
      },
      "IA-MCD-TOTALIOWA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "28/30 days",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IA audit doc; SOC default: physician-administered (onabotulinumtoxinA)"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "15/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IA audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IA audit doc"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IA audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: IV infusion (eptinezumab)"
        }
      },
      "IA-MCD-WELLPOINT": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Elevance PBM",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Elevance PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IA audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "28/30 days",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Elevance PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IA audit doc; SOC default: physician-administered (onabotulinumtoxinA)"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Elevance PBM",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "15/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Elevance PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IA audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Elevance PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IA audit doc"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Elevance PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IA audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Elevance PBM",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: IV infusion (eptinezumab)"
        }
      },
      "IA-PARTB-WPS": {
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "28/30 days",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IA audit doc; SOC default: physician-administered (onabotulinumtoxinA)"
        }
      },
      "ID-CHIP-BCI": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from ID audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: physician-administered (onabotulinumtoxinA)"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "18/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from ID audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: IV infusion (eptinezumab)"
        }
      },
      "ID-CHIP-MOLINA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from ID audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: physician-administered (onabotulinumtoxinA)"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "18/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from ID audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: IV infusion (eptinezumab)"
        }
      },
      "ID-COM-BCI": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from ID audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Prime Therapeutics national formulary; verify via payer portal"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Prime Therapeutics national formulary; verify via payer portal"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "18/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from ID audit doc"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Prime Therapeutics national formulary; verify via payer portal"
        }
      },
      "ID-COM-BCID": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from ID audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Prime Therapeutics national formulary; verify via payer portal"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Prime Therapeutics national formulary; verify via payer portal; SOC default: physician-administered (onabotulinumtoxinA)"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Prime Therapeutics national formulary; verify via payer portal"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "18/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from ID audit doc"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Prime Therapeutics national formulary; verify via payer portal"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "30/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from  national formulary; verify via payer portal | Remapped from ID-COM-BCIID"
        }
      },
      "ID-COM-PACIFIC": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "MedImpact",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "MedImpact",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "MedImpact",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: physician-administered (onabotulinumtoxinA)"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "MedImpact",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "18/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "MedImpact",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from ID audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "MedImpact",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "MedImpact",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "MedImpact",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: IV infusion (eptinezumab)"
        }
      },
      "ID-COM-REGENCE": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Regence PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        },
        "Ajovy": {
          "status": "",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Regence PBM",
          "confidence": "Gap-Manual-Review",
          "notes": "No audit data or PBM match; PBM=Regence PBM; requires manual verification"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Regence PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        }
      },
      "ID-COM-REGENCEBS": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from ID audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: physician-administered (onabotulinumtoxinA)"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "18/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from ID audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: IV infusion (eptinezumab)"
        }
      },
      "ID-COM-SELECT": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: physician-administered (onabotulinumtoxinA)"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "18/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from ID audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: IV infusion (eptinezumab)"
        }
      },
      "ID-COM-SELECTHEALTH": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "SelectHealth PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        },
        "Ajovy": {
          "status": "",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "SelectHealth PBM",
          "confidence": "Gap-Manual-Review",
          "notes": "No audit data or PBM match; PBM=SelectHealth PBM; requires manual verification"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "SelectHealth PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        }
      },
      "ID-COM-UHC": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from OptumRx national formulary; verify via payer portal"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Zavzpret": {
          "status": "",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Tier 4, PA, ST, QL"
        }
      },
      "ID-MA-AETNACARE": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from ID audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: physician-administered (onabotulinumtoxinA)"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "18/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from ID audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Aetna Medicare 2026 national policy: Vyepti (eptinezumab) is now non-preferred on the Part B drug list. Requires documen"
        }
      },
      "ID-MA-HUMANA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: physician-administered (onabotulinumtoxinA)"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "18/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from ID audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: IV infusion (eptinezumab)"
        }
      },
      "ID-MA-IDBCBS": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from ID audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: physician-administered (onabotulinumtoxinA)"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "18/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from ID audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: IV infusion (eptinezumab)"
        }
      },
      "ID-MA-REGENCEBS": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from ID audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: physician-administered (onabotulinumtoxinA)"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "18/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from ID audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: IV infusion (eptinezumab)"
        }
      },
      "ID-MA-UHC": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: physician-administered (onabotulinumtoxinA)"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "18/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from ID audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: IV infusion (eptinezumab)"
        }
      },
      "ID-MAC-NORIDIAN": {
        "Botox": {
          "status": "",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "N/A - Medical Benefit",
          "confidence": "Gap-Manual-Review",
          "notes": "No audit data or PBM match; PBM=N/A - Medical Benefit; requires manual verification; SOC default: physician-administered (onabotulinumtoxinA)"
        }
      },
      "ID-MCD-DHW": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from ID audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Prime Therapeutics national formulary; verify via payer portal"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Prime Therapeutics national formulary; verify via payer portal"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "30/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from  national formulary; verify via payer portal | Remapped from ID-MCD-IDMED"
        }
      },
      "ID-MCD-IDAHOBC": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from ID audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: physician-administered (onabotulinumtoxinA)"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "18/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from ID audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: IV infusion (eptinezumab)"
        }
      },
      "ID-MCD-IDDHW": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "State SPBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        },
        "Ajovy": {
          "status": "",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "State SPBM",
          "confidence": "Gap-Manual-Review",
          "notes": "No audit data or PBM match; PBM=State SPBM; requires manual verification"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "State SPBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        }
      },
      "ID-MCD-MOLINA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from ID audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: physician-administered (onabotulinumtoxinA)"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "18/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from ID audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: IV infusion (eptinezumab)"
        }
      },
      "ID-MCD-UHC": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: physician-administered (onabotulinumtoxinA)"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "18/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from ID audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: IV infusion (eptinezumab)"
        }
      },
      "ID-PARTB-NORIDIAN": {
        "Botox": {
          "status": "",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "",
          "confidence": "Gap-Manual-Review",
          "notes": "No audit data or PBM match; PBM=N/A; requires manual verification; SOC default: physician-administered (onabotulinumtoxinA)"
        }
      },
      "IL-CHIP-BCBS": {
        "Aimovig": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IL audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IL audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IL audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IL audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IL audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IL audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IL audit doc"
        }
      },
      "IL-CHIP-MERIDIAN": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Centene PBM",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Centene PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IL audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Centene PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IL audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Centene PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IL audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Centene PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IL audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Centene PBM",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Centene PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IL audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Centene PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IL audit doc"
        }
      },
      "IL-CHIP-MOLINA": {
        "Aimovig": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IL audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IL audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IL audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IL audit doc"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IL audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IL audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IL audit doc"
        }
      },
      "IL-COM-AETNA": {
        "Aimovig": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IL audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IL audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IL audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IL audit doc"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IL audit doc"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IL audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Home/Freestanding Preferred",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from CVS Caremark national formulary; verify via payer portal"
        }
      },
      "IL-COM-BCBSIL": {
        "Aimovig": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "Step through preferred CGRP",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "Step through preferred CGRP",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Botox": {
          "status": "Restricted",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Emgality": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "Step through preferred CGRP",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "5/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IL audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "30/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Prime Therapeutics national formulary; verify via payer portal"
        },
        "Ubrelvy": {
          "status": "Restricted",
          "tier": "Tier 3",
          "qty": "5/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Prime Therapeutics national formulary; verify via payer portal"
        }
      },
      "IL-COM-CIGNA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IL audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IL audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IL audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IL audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IL audit doc"
        }
      },
      "IL-COM-HUMANA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IL audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IL audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IL audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IL audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IL audit doc"
        }
      },
      "IL-COM-UHC": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "Fail Aimovig/Emgality before Ajovy/Vyepti",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "Fail Aimovig/Emgality before Ajovy/Vyepti",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IL audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "Fail Aimovig/Emgality before Ajovy/Vyepti",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IL audit doc"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IL audit doc"
        },
        "Vyepti": {
          "status": "Restricted",
          "tier": "",
          "qty": "",
          "stepInClass": "Fail SC CGRP before Vyepti",
          "siteOfCare": "Home/Freestanding Preferred",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": ""
        }
      },
      "IL-MA-AETNACARE": {
        "Aimovig": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IL audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IL audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IL audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IL audit doc"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IL audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IL audit doc"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Aetna Medicare 2026 national policy: Vyepti (eptinezumab) is now non-preferred on the Part B drug list. Requires documen"
        }
      },
      "IL-MA-CIGNA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IL audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IL audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IL audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IL audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IL audit doc"
        }
      },
      "IL-MA-HUMANA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IL audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IL audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IL audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IL audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IL audit doc"
        }
      },
      "IL-MA-ILBCBS": {
        "Aimovig": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IL audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IL audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IL audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IL audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IL audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IL audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IL audit doc"
        }
      },
      "IL-MA-UHC": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IL audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IL audit doc"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IL audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IL audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IL audit doc"
        }
      },
      "IL-MCD-AETNABETTER": {
        "Aimovig": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IL audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IL audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IL audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IL audit doc"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IL audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IL audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IL audit doc"
        }
      },
      "IL-MCD-COUNTYCARE": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IL audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IL audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IL audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IL audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IL audit doc"
        }
      },
      "IL-MCD-ILBCBS": {
        "Aimovig": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IL audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IL audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IL audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IL audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IL audit doc"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IL audit doc"
        }
      },
      "IL-MCD-MERIDIAN": {
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "30/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from  national formulary; verify via payer portal | Remapped from IL-MCD-ILHFS"
        },
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Envolve Pharmacy Solutions national formulary; verify via payer portal"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IL audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IL audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IL audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IL audit doc"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Envolve Pharmacy Solutions national formulary; verify via payer portal"
        }
      },
      "IL-MCD-MOLINA": {
        "Aimovig": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IL audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IL audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IL audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IL audit doc"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IL audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IL audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IL audit doc"
        }
      },
      "IL-MCD-YOUTHCARE": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IL audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IL audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IL audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IL audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IL audit doc"
        }
      },
      "IL-PARTB-NGS": {
        "Botox": {
          "status": "",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "N/A - Medicare",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        },
        "Vyepti": {
          "status": "",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "N/A - Medicare",
          "confidence": "Gap-Manual-Review",
          "notes": "No audit data or PBM match; PBM=N/A - Medicare; requires manual verification"
        }
      },
      "IN-CHIP-ANTHEM": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Elevance PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IN audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Elevance PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IN audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Elevance PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IN audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Elevance PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IN audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Elevance PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IN audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Elevance PBM",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Elevance PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IN audit doc"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Elevance PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IN audit doc"
        },
        "Zavzpret": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: status=Non-Preferred (PA required via SUPDL alignment), quantityLimit=6 devices/22 days"
        }
      },
      "IN-CHIP-MHS": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Centene PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IN audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Centene PBM",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Centene PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IN audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Centene PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IN audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Centene PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IN audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Centene PBM",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Centene PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IN audit doc"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Centene PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IN audit doc"
        },
        "Zavzpret": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: status=Non-Preferred (PA required via SUPDL alignment), quantityLimit=6 devices/22 days"
        }
      },
      "IN-COM-AETNA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IN audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IN audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IN audit doc"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 2",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IN audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IN audit doc"
        }
      },
      "IN-COM-ANTHEM": {
        "Aimovig": {
          "status": "Non-Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Carelon",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Carelon",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Carelon",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IN audit doc"
        },
        "Emgality": {
          "status": "Non-Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Carelon",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Carelon",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Carelon national formulary; verify via payer portal"
        }
      },
      "IN-COM-CIGNA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IN audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IN audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IN audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IN audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IN audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IN audit doc"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IN audit doc"
        }
      },
      "IN-COM-ELEV": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IN audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IN audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IN audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IN audit doc"
        }
      },
      "IN-COM-PHYSHEALTH": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IN audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IN audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IN audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IN audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IN audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IN audit doc"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IN audit doc"
        }
      },
      "IN-COM-UHC": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": ""
        }
      },
      "IN-MA-AETNACARE": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IN audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IN audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IN audit doc"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 2",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IN audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IN audit doc"
        }
      },
      "IN-MA-CIGNA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IN audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IN audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IN audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IN audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IN audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IN audit doc"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IN audit doc"
        }
      },
      "IN-MA-ELEV": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IN audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IN audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IN audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IN audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IN audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IN audit doc"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IN audit doc"
        }
      },
      "IN-MA-HUMANA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IN audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IN audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IN audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IN audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IN audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IN audit doc"
        }
      },
      "IN-MA-UHC": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IN audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IN audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IN audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IN audit doc"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 2",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IN audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IN audit doc"
        }
      },
      "IN-MCD-ANTHEM": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IN audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IN audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IN audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IN audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IN audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IN audit doc"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IN audit doc"
        },
        "Zavzpret": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: status=Non-Preferred (PA required), quantityLimit=6 devices/22 days"
        }
      },
      "IN-MCD-CARESOURCE": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IN audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IN audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IN audit doc"
        },
        "Zavzpret": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: status=Non-Preferred (PA required via SUPDL alignment), quantityLimit=6 devices/22 days"
        }
      },
      "IN-MCD-IHCP": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IHCP PBM",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IHCP PBM",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IHCP PBM",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Nurtec ODT": {
          "status": "",
          "tier": "Tier 2",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IHCP PBM",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ubrelvy": {
          "status": "",
          "tier": "Tier 2",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IHCP PBM",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Zavzpret": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: status=Non-Preferred, quantityLimit=6 devices/22 days"
        }
      },
      "IN-MCD-MANAGEDHEALTH": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IN audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IN audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IN audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IN audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IN audit doc"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IN audit doc"
        },
        "Zavzpret": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: status=Non-Preferred (PA required via SUPDL alignment), quantityLimit=6 devices/22 days"
        }
      },
      "IN-MCD-MDWISE": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IN audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IN audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IN audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IN audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IN audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IN audit doc"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IN audit doc"
        }
      },
      "IN-MCD-MHS": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Centene PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IN audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Centene PBM",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Centene PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IN audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Centene PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IN audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Centene PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IN audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Centene PBM",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Centene PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IN audit doc"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Centene PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IN audit doc"
        },
        "Zavzpret": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: status=Non-Preferred (PA required via SUPDL alignment), quantityLimit=6 devices/22 days"
        }
      },
      "IN-MCD-UHC": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IN audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IN audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IN audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IN audit doc"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 2",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IN audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IN audit doc"
        },
        "Zavzpret": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: status=Non-Preferred (PA required via SUPDL alignment), quantityLimit=6 devices/22 days"
        }
      },
      "IN-PARTB-WPS": {
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from IN audit doc"
        }
      },
      "KS-CHIP-AETNA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from KS audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: physician-administered (onabotulinumtoxinA)"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: IV infusion (eptinezumab)"
        }
      },
      "KS-CHIP-SUNFLOWER": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Centene PBM",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Centene PBM",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Centene PBM",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: physician-administered (onabotulinumtoxinA)"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Centene PBM",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Centene PBM",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Centene PBM",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Centene PBM",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Centene PBM",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: IV infusion (eptinezumab)"
        }
      },
      "KS-CHIP-UHC": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from KS audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: physician-administered (onabotulinumtoxinA)"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: IV infusion (eptinezumab)"
        }
      },
      "KS-COM-AETNA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from KS audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: physician-administered (onabotulinumtoxinA)"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: IV infusion (eptinezumab)"
        }
      },
      "KS-COM-AMBET": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from KS audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: physician-administered (onabotulinumtoxinA)"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: IV infusion (eptinezumab)"
        }
      },
      "KS-COM-BCBSKANSAS": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from KS audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Prime Therapeutics national formulary; verify via payer portal"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Prime Therapeutics national formulary; verify via payer portal; SOC default: physician-administered (onabotulinumtoxinA)"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Prime Therapeutics national formulary; verify via payer portal"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Prime Therapeutics national formulary; verify via payer portal"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Prime Therapeutics national formulary; verify via payer portal"
        }
      },
      "KS-COM-BCBSKS": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from KS audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Prime Therapeutics national formulary; verify via payer portal"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Prime Therapeutics national formulary; verify via payer portal"
        },
        "Nurtec ODT": {
          "status": "",
          "tier": "Specialty",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ubrelvy": {
          "status": "",
          "tier": "Specialty",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": ""
        }
      },
      "KS-COM-BLUEKC": {
        "Aimovig": {
          "status": "Excluded",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Unknown",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ajovy": {
          "status": "Excluded",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Unknown",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Botox": {
          "status": "",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Unknown",
          "confidence": "Gap-Manual-Review",
          "notes": "No audit data or PBM match; PBM=Unknown; requires manual verification; SOC default: physician-administered (onabotulinumtoxinA)"
        },
        "Emgality": {
          "status": "Excluded",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Unknown",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Nurtec ODT": {
          "status": "",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Unknown",
          "confidence": "Gap-Manual-Review",
          "notes": "No audit data or PBM match; PBM=Unknown; requires manual verification"
        },
        "Qulipta": {
          "status": "",
          "tier": "",
          "qty": "30/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Unknown",
          "confidence": "Gap-Manual-Review",
          "notes": "No audit data or PBM match; PBM=Unknown; requires manual verification"
        },
        "Ubrelvy": {
          "status": "",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Unknown",
          "confidence": "Gap-Manual-Review",
          "notes": "No audit data or PBM match; PBM=Unknown; requires manual verification"
        }
      },
      "KS-COM-CIGNA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from KS audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: physician-administered (onabotulinumtoxinA)"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: IV infusion (eptinezumab)"
        }
      },
      "KS-COM-UHC": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from OptumRx national formulary; verify via payer portal"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from KS audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from OptumRx national formulary; verify via payer portal; SOC default: physician-administered (onabotulinumtoxinA)"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from OptumRx national formulary; verify via payer portal"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from OptumRx national formulary; verify via payer portal"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from OptumRx national formulary; verify via payer portal"
        }
      },
      "KS-MA-AETNACARE": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from KS audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: physician-administered (onabotulinumtoxinA)"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: IV infusion (eptinezumab)"
        }
      },
      "KS-MA-HUMANA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from KS audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: physician-administered (onabotulinumtoxinA)"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: IV infusion (eptinezumab)"
        }
      },
      "KS-MA-KSBCBS": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from KS audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: physician-administered (onabotulinumtoxinA)"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: IV infusion (eptinezumab)"
        }
      },
      "KS-MA-UHC": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from KS audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: physician-administered (onabotulinumtoxinA)"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: IV infusion (eptinezumab)"
        }
      },
      "KS-MCD-AETNABETTER": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from KS audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: physician-administered (onabotulinumtoxinA)"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: IV infusion (eptinezumab)"
        }
      },
      "KS-MCD-HEALTHYBLUE": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from KS audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from CVS Caremark national formulary; verify via payer portal"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from CVS Caremark national formulary; verify via payer portal; SOC default: physician-administered (onabotulinumtoxinA)"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from CVS Caremark national formulary; verify via payer portal"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from CVS Caremark national formulary; verify via payer portal"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from CVS Caremark national formulary; verify via payer portal"
        }
      },
      "KS-MCD-SUNFLOWER": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Envolve Pharmacy Solutions national formulary; verify via payer portal"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Envolve Pharmacy Solutions national formulary; verify via payer portal"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Envolve Pharmacy Solutions national formulary; verify via payer portal; SOC default: physician-administered (onabotulinumtoxinA)"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Envolve Pharmacy Solutions national formulary; verify via payer portal"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Envolve Pharmacy Solutions national formulary; verify via payer portal"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Envolve Pharmacy Solutions national formulary; verify via payer portal"
        },
        "Emgality (Cluster)": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from  national formulary; verify via payer portal | Remapped from KS-MCD-SUNFLOWER-CLUSTER (cluster variant)"
        }
      },
      "KS-MCD-UHC": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from KS audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: physician-administered (onabotulinumtoxinA)"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: IV infusion (eptinezumab)"
        }
      },
      "KS-PARTB-WPS": {
        "Botox": {
          "status": "",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "",
          "confidence": "Gap-Manual-Review",
          "notes": "No audit data or PBM match; PBM=N/A; requires manual verification; SOC default: physician-administered (onabotulinumtoxinA)"
        }
      },
      "KS-PARTB-WPSGHA": {
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from  national formulary; verify via payer portal; SOC default: physician-administered (onabotulinumtoxinA)"
        }
      },
      "KY-CHIP-AETNA": {
        "Aimovig": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from KY audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from KY audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from KY audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from KY audit doc"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from KY audit doc"
        }
      },
      "KY-CHIP-ANTHEM": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Elevance PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from KY audit doc"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Elevance PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from KY audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Elevance PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from KY audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Elevance PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from KY audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Elevance PBM",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Elevance PBM",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Elevance PBM",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Elevance PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from KY audit doc"
        }
      },
      "KY-COM-AETNA": {
        "Aimovig": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from KY audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from KY audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from KY audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from KY audit doc"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from KY audit doc"
        }
      },
      "KY-COM-ANTHEM": {
        "Aimovig": {
          "status": "",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Carelon",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ajovy": {
          "status": "",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Carelon",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Emgality": {
          "status": "",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Carelon",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Carelon",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Carelon national formulary; verify via payer portal"
        },
        "Qulipta": {
          "status": "",
          "tier": "Tier 3",
          "qty": "30/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Carelon",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Carelon",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Carelon national formulary; verify via payer portal"
        }
      },
      "KY-COM-ELEV": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from KY audit doc"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from KY audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from KY audit doc"
        }
      },
      "KY-COM-HUMANA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from KY audit doc"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from KY audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from KY audit doc"
        }
      },
      "KY-COM-UHC": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from KY audit doc"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from KY audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from KY audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from KY audit doc"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from OptumRx national formulary; verify via payer portal"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from OptumRx national formulary; verify via payer portal"
        }
      },
      "KY-MA-AETNACARE": {
        "Aimovig": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from KY audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from KY audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from KY audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from KY audit doc"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from KY audit doc"
        }
      },
      "KY-MA-ELEV": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from KY audit doc"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from KY audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from KY audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from KY audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from KY audit doc"
        }
      },
      "KY-MA-HUMANA": {
        "Botox": {
          "status": "Non-Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": ""
        }
      },
      "KY-MA-UHC": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from KY audit doc"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from KY audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from KY audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from KY audit doc"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from KY audit doc"
        }
      },
      "KY-MCD-AETNA": {
        "Aimovig": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from KY audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from KY audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from KY audit doc"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from CVS Caremark national formulary; verify via payer portal"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from CVS Caremark national formulary; verify via payer portal"
        }
      },
      "KY-MCD-AETNABETTER": {
        "Aimovig": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from KY audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from KY audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from KY audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from KY audit doc"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from KY audit doc"
        }
      },
      "KY-MCD-ANTHEM": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from KY audit doc"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from KY audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from KY audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from KY audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from KY audit doc"
        }
      },
      "KY-MCD-HUMANA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from KY audit doc"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from KY audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from KY audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from KY audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from KY audit doc"
        }
      },
      "KY-MCD-PASSPORT": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from KY audit doc"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from KY audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from KY audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from KY audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from KY audit doc"
        }
      },
      "KY-MCD-UHC": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from KY audit doc"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from KY audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from KY audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from KY audit doc"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from KY audit doc"
        }
      },
      "KY-MCD-WELLCARE": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from KY audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from KY audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from KY audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from KY audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from KY audit doc"
        }
      },
      "KY-PARTB-CGS": {
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from KY audit doc"
        }
      },
      "LA-CHIP-AETNA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from LA audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from LA audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from LA audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Home Infusion",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from LA audit doc"
        },
        "Zavzpret": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Non-Preferred (Requires PA); Trial of 2 oral triptans required"
        }
      },
      "LA-CHIP-HEALTHYBLUE": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Elevance PBM",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Elevance PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from LA audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Elevance PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from LA audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Elevance PBM",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Elevance PBM",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Elevance PBM",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Elevance PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from LA audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Home Infusion",
          "pbm": "Elevance PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from LA audit doc"
        },
        "Zavzpret": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Non-Preferred (Requires PA); Trial of 2 oral triptans required"
        }
      },
      "LA-CHIP-UHC": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from LA audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from LA audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from LA audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Home Infusion",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from LA audit doc"
        }
      },
      "LA-COM-AETNA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from LA audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from LA audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from LA audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Home Infusion",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from LA audit doc"
        }
      },
      "LA-COM-BCBSLA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "BCBSLA PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "BCBSLA PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        },
        "Emgality": {
          "status": "",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "BCBSLA PBM",
          "confidence": "Gap-Manual-Review",
          "notes": "No audit data or PBM match; PBM=BCBSLA PBM; requires manual verification"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "BCBSLA PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "BCBSLA PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        },
        "Zavzpret": {
          "status": "Covered",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Covered under Medical Policy 00646; Requires trial and failure of 1 generic triptan medication"
        }
      },
      "LA-COM-HUMANA": {
        "Aimovig": {
          "status": "Excluded",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Excluded / Nonformulary"
        },
        "Ajovy": {
          "status": "Excluded",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Excluded / Nonformulary"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from LA audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Excluded",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Excluded / Nonformulary"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Excluded",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Home Infusion",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Excluded / Nonformulary"
        }
      },
      "LA-COM-LABLUE": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from LA audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Prime Therapeutics national formulary; verify via payer portal"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Prime Therapeutics national formulary; verify via payer portal"
        },
        "Zavzpret": {
          "status": "Covered",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Covered under Medical Policy 00646; Requires trial and failure of 1 generic triptan medication"
        }
      },
      "LA-COM-UHC": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from OptumRx national formulary; verify via payer portal"
        },
        "Ajovy": {
          "status": "Excluded",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Excluded (Tier E)"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from OptumRx national formulary; verify via payer portal"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "30/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from OptumRx national formulary; verify via payer portal"
        },
        "Zavzpret": {
          "status": "Covered",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Covered, Tier 3, PA/ST/QL required"
        }
      },
      "LA-COM-VANTAGE": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from LA audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from LA audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from LA audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Home Infusion",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from LA audit doc"
        }
      },
      "LA-MA-AETNACARE": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from LA audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from LA audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from LA audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Home Infusion",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from LA audit doc"
        }
      },
      "LA-MA-HUMANA": {
        "Aimovig": {
          "status": "Excluded",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Excluded / Nonformulary"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from LA audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from LA audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Excluded",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Excluded / Nonformulary"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Home Infusion",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from LA audit doc"
        }
      },
      "LA-MA-LABCBS": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from LA audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from LA audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from LA audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Home Infusion",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from LA audit doc"
        }
      },
      "LA-MA-UHC": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from LA audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from LA audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from LA audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Home Infusion",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from LA audit doc"
        }
      },
      "LA-MA-VANTAGEHEALTH": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from LA audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from LA audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from LA audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Home Infusion",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from LA audit doc"
        }
      },
      "LA-MCD-AETNABETTER": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from LA audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from LA audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from LA audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Home Infusion",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from LA audit doc"
        },
        "Zavzpret": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Non-Preferred (Requires PA); Trial of 2 oral triptans required"
        }
      },
      "LA-MCD-AMERIHEALTH": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from LA audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from LA audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from LA audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Home Infusion",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from LA audit doc"
        },
        "Zavzpret": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Non-Preferred (Requires PA); Trial of 2 oral triptans required"
        }
      },
      "LA-MCD-HEALTHYBLUE": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from LA audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from LA audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from LA audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Home Infusion",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from LA audit doc"
        },
        "Zavzpret": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Non-Preferred (Requires PA); Trial of 2 oral triptans required"
        }
      },
      "LA-MCD-LACONNECT": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from LA audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from LA audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Home Infusion",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from LA audit doc"
        },
        "Zavzpret": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Non-Preferred (Requires PA); Trial of 2 oral triptans required"
        }
      },
      "LA-MCD-LHC": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "State SPBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "State SPBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        },
        "Emgality": {
          "status": "",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "State SPBM",
          "confidence": "Gap-Manual-Review",
          "notes": "No audit data or PBM match; PBM=State SPBM; requires manual verification"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "State SPBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "State SPBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        },
        "Zavzpret": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Non-Preferred (Requires PA); Trial of 2 oral triptans required"
        }
      },
      "LA-MCD-UHC": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from LA audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from LA audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from LA audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Home Infusion",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from LA audit doc"
        }
      },
      "LA-PARTB-NOVITAS": {
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from LA audit doc"
        }
      },
      "MA-COM-AETNA": {
        "Aimovig": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MA audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MA audit doc"
        }
      },
      "MA-COM-BCBSMA-CLUSTER": {
        "Emgality (Cluster)": {
          "status": "Restricted",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": ""
        }
      },
      "MA-COM-FALLON": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MA audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MA audit doc"
        }
      },
      "MA-COM-HARVARD": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Express Scripts national formulary; verify via payer portal"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Express Scripts national formulary; verify via payer portal"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Express Scripts national formulary; verify via payer portal"
        }
      },
      "MA-COM-MASSBCBS": {
        "Aimovig": {
          "status": "Non-Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MA audit doc"
        },
        "Emgality": {
          "status": "Non-Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Emgality (Cluster)": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Prime Therapeutics national formulary; verify via payer portal"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Prime Therapeutics national formulary; verify via payer portal"
        },
        "Ubrelvy": {
          "status": "Restricted",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Zavzpret": {
          "status": "",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Tier 4c"
        }
      },
      "MA-COM-POINT32": {
        "Aimovig": {
          "status": "Excluded",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Point32Health PBM",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ajovy": {
          "status": "Excluded",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Point32Health PBM",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Botox": {
          "status": "",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Point32Health PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        },
        "Emgality": {
          "status": "Excluded",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Point32Health PBM",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Nurtec ODT": {
          "status": "",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Point32Health PBM",
          "confidence": "Gap-Manual-Review",
          "notes": "No audit data or PBM match; PBM=Point32Health PBM; requires manual verification"
        },
        "Ubrelvy": {
          "status": "",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Point32Health PBM",
          "confidence": "Gap-Manual-Review",
          "notes": "No audit data or PBM match; PBM=Point32Health PBM; requires manual verification"
        }
      },
      "MA-COM-TUFTS": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Express Scripts national formulary; verify via payer portal"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Express Scripts national formulary; verify via payer portal"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Express Scripts national formulary; verify via payer portal"
        }
      },
      "MA-COM-UHC": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from OptumRx national formulary; verify via payer portal"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Zavzpret": {
          "status": "",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Tier 4 (Subject to PA, ST, QL)"
        }
      },
      "MA-MA-AETNACARE": {
        "Aimovig": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MA audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MA audit doc"
        }
      },
      "MA-MA-HARVARD": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MA audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MA audit doc"
        }
      },
      "MA-MA-HUMANA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MA audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MA audit doc"
        }
      },
      "MA-MA-MABCBS": {
        "Aimovig": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MA audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MA audit doc"
        }
      },
      "MA-MA-TUFTS": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MA audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MA audit doc"
        }
      },
      "MA-MA-UHC": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MA audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MA audit doc"
        }
      },
      "MA-MAC-NGS": {
        "Botox": {
          "status": "",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "N/A - Medical Benefit",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        }
      },
      "MA-MCD-BMCHEALTH": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MA audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MA audit doc"
        }
      },
      "MA-MCD-FALLON": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MA audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MA audit doc"
        }
      },
      "MA-MCD-HEALTHNEW": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MA audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MA audit doc"
        }
      },
      "MA-MCD-MASSBRIGHAM": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Express Scripts national formulary; verify via payer portal"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": ""
        }
      },
      "MA-MCD-MASSHEALTH": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Conduent (FFS) / OptumRx-CVS for ACOs",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Conduent (FFS) / OptumRx-CVS for ACOs national formulary; verify via payer portal"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Conduent (FFS) / OptumRx-CVS for ACOs",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Conduent (FFS) / OptumRx-CVS for ACOs national formulary; verify via payer portal"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Conduent (FFS) / OptumRx-CVS for ACOs",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MA audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Conduent (FFS) / OptumRx-CVS for ACOs",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Conduent (FFS) / OptumRx-CVS for ACOs national formulary; verify via payer portal"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Conduent (FFS) / OptumRx-CVS for ACOs",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Conduent (FFS) / OptumRx-CVS for ACOs national formulary; verify via payer portal"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Conduent (FFS) / OptumRx-CVS for ACOs",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Conduent (FFS) / OptumRx-CVS for ACOs national formulary; verify via payer portal"
        },
        "Zavzpret": {
          "status": "Covered",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Covered with Prior Authorization"
        }
      },
      "MA-MCD-TUFTS": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MA audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MA audit doc"
        }
      },
      "MA-MCD-WELLSENSE": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MA audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MA audit doc"
        }
      },
      "MA-PARTB-NGS": {
        "Botox": {
          "status": "",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "N/A - Medicare",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        },
        "Vyepti": {
          "status": "Restricted",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "N/A - Medicare",
          "confidence": "Audit-Derived",
          "notes": ""
        }
      },
      "MD-CHIP-AMERIGROUP": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Elevance PBM",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Elevance PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MD audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Home Infusion",
          "pbm": "Elevance PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MD audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Elevance PBM",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Elevance PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MD audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Elevance PBM",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Elevance PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MD audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Home Infusion",
          "pbm": "Elevance PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MD audit doc"
        }
      },
      "MD-COM-AETNA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MD audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Home Infusion",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MD audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MD audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MD audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Home Infusion",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MD audit doc"
        }
      },
      "MD-COM-CAREFIRST": {
        "Aimovig": {
          "status": "Non-Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Home Infusion",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MD audit doc"
        },
        "Emgality": {
          "status": "Non-Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "30/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from CVS Caremark national formulary; verify via payer portal"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": ""
        }
      },
      "MD-COM-CIGNA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MD audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Home Infusion",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MD audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MD audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MD audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Home Infusion",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MD audit doc"
        },
        "Zavzpret": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Preferred Brand / Tier 2"
        }
      },
      "MD-COM-KAISER": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Kaiser Permanente (Internal)/MedImpact",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Kaiser Permanente (Internal)/MedImpact national formulary; verify via payer portal"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Kaiser Permanente (Internal)/MedImpact",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MD audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Home Infusion",
          "pbm": "Kaiser Permanente (Internal)/MedImpact",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MD audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Kaiser Permanente (Internal)/MedImpact",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Kaiser Permanente (Internal)/MedImpact national formulary; verify via payer portal"
        }
      },
      "MD-COM-UHC": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ajovy": {
          "status": "Excluded",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Site of Care Review Required",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from OptumRx national formulary; verify via payer portal"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MD audit doc"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MD audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Home Infusion",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MD audit doc"
        }
      },
      "MD-MA-AETNACARE": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MD audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Home Infusion",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MD audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MD audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MD audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Home Infusion",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MD audit doc"
        }
      },
      "MD-MA-CAREBCBS": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MD audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Home Infusion",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MD audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MD audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MD audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Home Infusion",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MD audit doc"
        }
      },
      "MD-MA-HUMANA": {
        "Aimovig": {
          "status": "Not Covered",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Nonformulary (not covered)"
        },
        "Ajovy": {
          "status": "Not Covered",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Nonformulary (not covered)"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Home Infusion",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MD audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Not Covered",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Nonformulary (not covered)"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MD audit doc"
        },
        "Vyepti": {
          "status": "Not Covered",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Home Infusion",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Nonformulary (not covered)"
        }
      },
      "MD-MA-KAISER": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Kaiser Permanente (Internal)/MedImpact",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Kaiser Permanente (Internal)/MedImpact",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MD audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Home Infusion",
          "pbm": "Kaiser Permanente (Internal)/MedImpact",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MD audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Kaiser Permanente (Internal)/MedImpact",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Kaiser Permanente (Internal)/MedImpact",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MD audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Kaiser Permanente (Internal)/MedImpact",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Kaiser Permanente (Internal)/MedImpact",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MD audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Home Infusion",
          "pbm": "Kaiser Permanente (Internal)/MedImpact",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MD audit doc"
        }
      },
      "MD-MA-UHC": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MD audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Home Infusion",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MD audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MD audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MD audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Home Infusion",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MD audit doc"
        }
      },
      "MD-MAC-NOVITAS": {
        "Botox": {
          "status": "",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Home Infusion",
          "pbm": "N/A - Medical Benefit",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        }
      },
      "MD-MCD-AETNABETTER": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MD audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Home Infusion",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MD audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MD audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MD audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Home Infusion",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MD audit doc"
        }
      },
      "MD-MCD-CAREFIRST": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MD audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Home Infusion",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MD audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MD audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MD audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Home Infusion",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MD audit doc"
        }
      },
      "MD-MCD-MDPHYSICIANS": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MD audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Home Infusion",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MD audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MD audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MD audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Home Infusion",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MD audit doc"
        }
      },
      "MD-MCD-MEDSTARFAMILY": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MD audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Home Infusion",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MD audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MD audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MD audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Home Infusion",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MD audit doc"
        }
      },
      "MD-MCD-MPC": {
        "Aimovig": {
          "status": "Non-Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "State SPBM",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "State SPBM",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Emgality": {
          "status": "Non-Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "State SPBM",
          "confidence": "Audit-Derived",
          "notes": ""
        }
      },
      "MD-MCD-PRIORITY": {
        "Aimovig": {
          "status": "Non-Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Priority Partners PBM",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Priority Partners PBM",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Botox": {
          "status": "",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Home Infusion",
          "pbm": "Priority Partners PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        },
        "Emgality": {
          "status": "Non-Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Priority Partners PBM",
          "confidence": "Audit-Derived",
          "notes": ""
        }
      },
      "MD-MCD-PRIORITYPART": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MD audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Home Infusion",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MD audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MD audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MD audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Home Infusion",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MD audit doc"
        }
      },
      "MD-MCD-UHC": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MD audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Home Infusion",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MD audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MD audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MD audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Home Infusion",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MD audit doc"
        }
      },
      "MD-PARTB-NOVITAS": {
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Home Infusion",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MD audit doc"
        }
      },
      "ME-COM-AETNA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from ME audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from ME audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from ME audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from ME audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from ME audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from ME audit doc; SOC default: IV infusion (eptinezumab)"
        }
      },
      "ME-COM-ANTHEM": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CarelonRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CarelonRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CarelonRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CarelonRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        },
        "Qulipta": {
          "status": "",
          "tier": "",
          "qty": "30/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CarelonRx",
          "confidence": "Gap-Manual-Review",
          "notes": "No audit data or PBM match; PBM=CarelonRx; requires manual verification"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CarelonRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        }
      },
      "ME-COM-CHO": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Express Scripts national formulary; verify via payer portal"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from ME audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from ME audit doc"
        }
      },
      "ME-COM-COMMHEALTH": {
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from ME audit doc"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from ME audit doc"
        }
      },
      "ME-COM-ELEV": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from IngenioRx (Carelon) national formulary; verify via payer portal"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from ME audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from ME audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from ME audit doc"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from ME audit doc"
        }
      },
      "ME-COM-HARVARD": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Express Scripts national formulary; verify via payer portal"
        },
        "Ajovy": {
          "status": "Excluded",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from ME audit doc"
        }
      },
      "ME-COM-UHC": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from ME audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from ME audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from ME audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from ME audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from ME audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from ME audit doc; SOC default: IV infusion (eptinezumab)"
        }
      },
      "ME-MA-AETNACARE": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from ME audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from ME audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from ME audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from ME audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from ME audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from ME audit doc; SOC default: IV infusion (eptinezumab)"
        }
      },
      "ME-MA-ELEV": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from ME audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from ME audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from ME audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from ME audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from ME audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from ME audit doc; SOC default: IV infusion (eptinezumab)"
        }
      },
      "ME-MA-MARTINS": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from ME audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from ME audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from ME audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from ME audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from ME audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from ME audit doc; SOC default: IV infusion (eptinezumab)"
        }
      },
      "ME-MA-UHC": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from ME audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from ME audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from ME audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from ME audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from ME audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from ME audit doc; SOC default: IV infusion (eptinezumab)"
        }
      },
      "ME-MAC-NGS": {
        "Botox": {
          "status": "",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "N/A - Medical Benefit",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        }
      },
      "ME-MCD-DHHS": {
        "Aimovig": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Change Healthcare",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Change Healthcare",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Emgality": {
          "status": "Non-Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Change Healthcare",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Change Healthcare",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Change Healthcare",
          "confidence": "Audit-Derived",
          "notes": ""
        }
      },
      "ME-MCD-MAINECARE": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "State SPBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "State SPBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "State SPBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "State SPBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        },
        "Qulipta": {
          "status": "",
          "tier": "",
          "qty": "30/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "State SPBM",
          "confidence": "Gap-Manual-Review",
          "notes": "No audit data or PBM match; PBM=State SPBM; requires manual verification"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "State SPBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        }
      },
      "ME-PARTB-NGS": {
        "Botox": {
          "status": "",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        }
      },
      "MI-CHIP-MERIDIAN": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Centene PBM",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Centene PBM",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Centene PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MI audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Centene PBM",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Centene PBM",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Centene PBM",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Centene PBM",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Centene PBM",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: IV infusion (eptinezumab)"
        },
        "Zavzpret": {
          "status": "Covered",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Covered with PA (Quantity Limit: 8 devices per 30 days)"
        }
      },
      "MI-CHIP-MOLINA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MI audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MI audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: IV infusion (eptinezumab)"
        },
        "Zavzpret": {
          "status": "Covered",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Covered with PA (Quantity Limit: 8 devices per 30 days)"
        }
      },
      "MI-CHIP-UHC": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MI audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: IV infusion (eptinezumab)"
        },
        "Zavzpret": {
          "status": "Covered",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Covered with PA (Quantity Limit: 8 devices per 30 days)"
        }
      },
      "MI-COM-AETNA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MI audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MI audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: IV infusion (eptinezumab)"
        }
      },
      "MI-COM-ALLIANCE": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MI audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: IV infusion (eptinezumab)"
        }
      },
      "MI-COM-BCBSM": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "BCBSM PBM",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ajovy": {
          "status": "",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "BCBSM PBM",
          "confidence": "Gap-Manual-Review",
          "notes": "No audit data or PBM match; PBM=BCBSM PBM; requires manual verification"
        },
        "Botox": {
          "status": "",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "BCBSM PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "BCBSM PBM",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Nurtec ODT": {
          "status": "",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "BCBSM PBM",
          "confidence": "Gap-Manual-Review",
          "notes": "No audit data or PBM match; PBM=BCBSM PBM; requires manual verification"
        },
        "Ubrelvy": {
          "status": "",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "BCBSM PBM",
          "confidence": "Gap-Manual-Review",
          "notes": "No audit data or PBM match; PBM=BCBSM PBM; requires manual verification"
        }
      },
      "MI-COM-MICHBCBS": {
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "30/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from  national formulary; verify via payer portal | Remapped from MI-COM-BCBSMI"
        },
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MI audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Prime Therapeutics national formulary; verify via payer portal"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Prime Therapeutics national formulary; verify via payer portal"
        }
      },
      "MI-COM-PRIORITY": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Express Scripts national formulary; verify via payer portal"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Express Scripts national formulary; verify via payer portal"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MI audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Express Scripts national formulary; verify via payer portal"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Express Scripts national formulary; verify via payer portal"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Express Scripts national formulary; verify via payer portal"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Express Scripts national formulary; verify via payer portal"
        }
      },
      "MI-COM-UHC": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "Fail Aimovig first",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "Fail Aimovig first",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MI audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "Fail Aimovig first",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from OptumRx national formulary; verify via payer portal"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from OptumRx national formulary; verify via payer portal"
        }
      },
      "MI-MA-AETNACARE": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MI audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MI audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: IV infusion (eptinezumab)"
        }
      },
      "MI-MA-HUMANA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MI audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: IV infusion (eptinezumab)"
        }
      },
      "MI-MA-MIBCBS": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MI audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MI audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: IV infusion (eptinezumab)"
        }
      },
      "MI-MA-PRIORITYH": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MI audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: IV infusion (eptinezumab)"
        }
      },
      "MI-MA-UHC": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MI audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: IV infusion (eptinezumab)"
        }
      },
      "MI-MCD-AETNABETTER": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MI audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MI audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: IV infusion (eptinezumab)"
        },
        "Zavzpret": {
          "status": "Covered",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Covered with PA (Quantity Limit: 8 devices per 30 days)"
        }
      },
      "MI-MCD-HAPMIDWEST": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MI audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: IV infusion (eptinezumab)"
        },
        "Zavzpret": {
          "status": "Covered",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Covered with PA (Quantity Limit: 8 devices per 30 days)"
        }
      },
      "MI-MCD-MCLARENHEALTH": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MI audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: IV infusion (eptinezumab)"
        },
        "Zavzpret": {
          "status": "Covered",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Covered with PA (Quantity Limit: 8 devices per 30 days)"
        }
      },
      "MI-MCD-MERIDIAN": {
        "Aimovig": {
          "status": "Non-Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Emgality": {
          "status": "Non-Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Envolve Pharmacy Solutions national formulary; verify via payer portal"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Envolve Pharmacy Solutions national formulary; verify via payer portal"
        },
        "Zavzpret": {
          "status": "Covered",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Covered with PA (Quantity Limit: 8 devices per 30 days)"
        }
      },
      "MI-MCD-MIBCBS": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MI audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MI audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: IV infusion (eptinezumab)"
        },
        "Zavzpret": {
          "status": "Covered",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Covered with PA (Quantity Limit: 8 devices per 30 days)"
        }
      },
      "MI-MCD-MOLINA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MI audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MI audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: IV infusion (eptinezumab)"
        },
        "Zavzpret": {
          "status": "Covered",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Covered with PA (Quantity Limit: 8 devices per 30 days)"
        }
      },
      "MI-MCD-PRIORITYHEALTH": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MI audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: IV infusion (eptinezumab)"
        },
        "Zavzpret": {
          "status": "Covered",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Covered with PA (Quantity Limit: 8 devices per 30 days)"
        }
      },
      "MI-MCD-UHC": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MI audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: IV infusion (eptinezumab)"
        },
        "Zavzpret": {
          "status": "Covered",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Covered with PA (Quantity Limit: 8 devices per 30 days)"
        }
      },
      "MI-PARTB-WPS": {
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MI audit doc"
        }
      },
      "MN-CHIP-BLUEPLUS": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MN audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MN audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MN audit doc; SOC default: IV infusion (eptinezumab)"
        },
        "Zavzpret": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Non-preferred, PA Required, ST Required"
        }
      },
      "MN-COM-MINNBCBS": {
        "Qulipta": {
          "status": "",
          "tier": "Tier 4",
          "qty": "30/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "| Remapped from MN-COM-BCBSMN"
        },
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MN audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Prime Therapeutics national formulary; verify via payer portal"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MN audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Prime Therapeutics national formulary; verify via payer portal"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Prime Therapeutics national formulary; verify via payer portal"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Prime Therapeutics national formulary; verify via payer portal"
        }
      },
      "MN-COM-PARTNERS": {
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "30/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from  national formulary; verify via payer portal | Remapped from MN-COM-HEALTHPART"
        },
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Express Scripts national formulary; verify via payer portal"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MN audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MN audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Express Scripts national formulary; verify via payer portal"
        },
        "Nurtec ODT": {
          "status": "",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ubrelvy": {
          "status": "",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": ""
        }
      },
      "MN-COM-MEDICA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MN audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Express Scripts national formulary; verify via payer portal"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Express Scripts national formulary; verify via payer portal"
        }
      },
      "MN-COM-PREFERONE": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MN audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MN audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MN audit doc; SOC default: IV infusion (eptinezumab)"
        }
      },
      "MN-COM-UHC": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MN audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MN audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Zavzpret": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Tier 4, Non-Preferred, PA Required, ST Required, QL Applies"
        }
      },
      "MN-MA-HPARTNERS": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MN audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MN audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MN audit doc; SOC default: IV infusion (eptinezumab)"
        }
      },
      "MN-MA-MEDICA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MN audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MN audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MN audit doc; SOC default: IV infusion (eptinezumab)"
        }
      },
      "MN-MA-MNBCBS": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MN audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MN audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MN audit doc; SOC default: IV infusion (eptinezumab)"
        }
      },
      "MN-MA-UCAREMN": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MN audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MN audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MN audit doc; SOC default: IV infusion (eptinezumab)"
        }
      },
      "MN-MA-UHC": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MN audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MN audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MN audit doc; SOC default: IV infusion (eptinezumab)"
        }
      },
      "MN-MAC-NGS": {
        "Botox": {
          "status": "",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "N/A - Medical Benefit",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        }
      },
      "MN-MCD-BLUEPLUS": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MN audit doc"
        },
        "Emgality": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Prime Therapeutics national formulary; verify via payer portal"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Zavzpret": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Non-preferred, PA Required, ST Required"
        }
      },
      "MN-MCD-HENNEPIN": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MN audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MN audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MN audit doc; SOC default: IV infusion (eptinezumab)"
        },
        "Zavzpret": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Non-preferred, PA Required, ST Required"
        }
      },
      "MN-MCD-MEDICA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MN audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MN audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MN audit doc; SOC default: IV infusion (eptinezumab)"
        },
        "Zavzpret": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Non-preferred, PA Required, ST Required"
        }
      },
      "MN-MCD-PARTNERS": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MN audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MN audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MN audit doc; SOC default: IV infusion (eptinezumab)"
        },
        "Zavzpret": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Non-preferred, PA Required, ST Required"
        }
      },
      "MN-MCD-UCARE": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MN audit doc"
        },
        "Emgality": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Zavzpret": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Non-preferred, PA Required, ST Required"
        }
      },
      "MN-MCD-UHC": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MN audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MN audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MN audit doc; SOC default: IV infusion (eptinezumab)"
        },
        "Zavzpret": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Non-preferred, PA Required, ST Required"
        }
      },
      "MN-PARTB-NGS": {
        "Vyepti": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MN audit doc"
        }
      },
      "MO-CHIP-ANTHEM": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Elevance PBM",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Elevance PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MO audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Elevance PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MO audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Elevance PBM",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Elevance PBM",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Elevance PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MO audit doc"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Elevance PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MO audit doc"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Elevance PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MO audit doc"
        }
      },
      "MO-CHIP-HOMESTATE": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Centene PBM",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Centene PBM",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Centene PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MO audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Centene PBM",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Centene PBM",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Centene PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MO audit doc"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Centene PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MO audit doc"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Centene PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MO audit doc"
        }
      },
      "MO-CHIP-UHC": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MO audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MO audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MO audit doc"
        },
        "Qulipta": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MO audit doc"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MO audit doc"
        }
      },
      "MO-COM-AETNA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MO audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MO audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MO audit doc"
        },
        "Qulipta": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MO audit doc"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MO audit doc"
        }
      },
      "MO-COM-AMBET": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MO audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MO audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MO audit doc"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MO audit doc"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MO audit doc"
        }
      },
      "MO-COM-ANTHEM": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Elevance PBM",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Elevance PBM",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Emgality": {
          "status": "Excluded",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Elevance PBM",
          "confidence": "Audit-Derived",
          "notes": ""
        }
      },
      "MO-COM-BLUEKC": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Blue KC PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        },
        "Ajovy": {
          "status": "Excluded",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Blue KC PBM",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Emgality": {
          "status": "Excluded",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Blue KC PBM",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Tier 2"
        }
      },
      "MO-COM-CIGNA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MO audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MO audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MO audit doc"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MO audit doc"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MO audit doc"
        }
      },
      "MO-COM-ELEV": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from IngenioRx (Carelon) national formulary; verify via payer portal"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MO audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from IngenioRx (Carelon) national formulary; verify via payer portal"
        }
      },
      "MO-COM-UHC": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MO audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Qulipta": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "30/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MO audit doc"
        }
      },
      "MO-MA-AETNACARE": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MO audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MO audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MO audit doc"
        },
        "Qulipta": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MO audit doc"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MO audit doc"
        }
      },
      "MO-MA-CIGNA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MO audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MO audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MO audit doc"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MO audit doc"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MO audit doc"
        }
      },
      "MO-MA-ELEV": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MO audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MO audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MO audit doc"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MO audit doc"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MO audit doc"
        }
      },
      "MO-MA-HUMANA": {
        "Aimovig": {
          "status": "Excluded",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Excluded (Nonformulary)"
        },
        "Ajovy": {
          "status": "Excluded",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Excluded (Nonformulary)"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MO audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Tier 4"
        },
        "Nurtec ODT": {
          "status": "Excluded",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Excluded (Nonformulary)"
        },
        "Qulipta": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MO audit doc"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Excluded",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Excluded (Nonformulary)"
        }
      },
      "MO-MA-UHC": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MO audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MO audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MO audit doc"
        },
        "Qulipta": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MO audit doc"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MO audit doc"
        }
      },
      "MO-MCD-HEALTHYBLUE": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MO audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MO audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MO audit doc"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MO audit doc"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MO audit doc"
        }
      },
      "MO-MCD-HOMESTATE": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MO audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MO audit doc"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MO audit doc"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MO audit doc"
        }
      },
      "MO-MCD-MHN": {
        "Aimovig": {
          "status": "Non-Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "MO HealthNet PBM",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "MO HealthNet PBM",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Emgality": {
          "status": "Non-Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "MO HealthNet PBM",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 1",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "MO HealthNet PBM",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Nurtec ODT (Preventive)": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "MO HealthNet PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 1",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "MO HealthNet PBM",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Zavzpret": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Non-Preferred; Requires trial of Ubrelvy or Reyvow; QL 6 units per 22 days"
        }
      },
      "MO-MCD-UHC": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MO audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MO audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MO audit doc"
        },
        "Qulipta": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MO audit doc"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MO audit doc"
        }
      },
      "MO-PARTB-WPS": {
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MO audit doc"
        }
      },
      "MS-CHIP-MAGNOLIA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Centene PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MS audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Centene PBM",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Centene PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MS audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Centene PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MS audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Centene PBM",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Centene PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MS audit doc"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Centene PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MS audit doc"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Centene PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MS audit doc"
        }
      },
      "MS-CHIP-MOLINA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MS audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MS audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MS audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MS audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MS audit doc"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MS audit doc"
        }
      },
      "MS-CHIP-UHC": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MS audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MS audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MS audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MS audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MS audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MS audit doc"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MS audit doc"
        }
      },
      "MS-COM-AETNA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MS audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MS audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MS audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MS audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MS audit doc"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MS audit doc"
        }
      },
      "MS-COM-AMBET": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MS audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MS audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MS audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MS audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MS audit doc"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MS audit doc"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MS audit doc"
        }
      },
      "MS-COM-BCBSMS": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "BCBSMS PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "BCBSMS PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "BCBSMS PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "BCBSMS PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "BCBSMS PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        },
        "Qulipta": {
          "status": "Excluded",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Not Medically Necessary / Excluded"
        },
        "Zavzpret": {
          "status": "Excluded",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Not Medically Necessary / Excluded"
        }
      },
      "MS-COM-HUMANA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MS audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MS audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MS audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MS audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MS audit doc"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MS audit doc"
        }
      },
      "MS-COM-MISSBCBS": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MS audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MS audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MS audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MS audit doc"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MS audit doc"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MS audit doc"
        }
      },
      "MS-COM-UHC": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MS audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "30/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MS audit doc"
        }
      },
      "MS-MA-AETNACARE": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MS audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MS audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MS audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MS audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MS audit doc"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MS audit doc"
        }
      },
      "MS-MA-HUMANA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MS audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MS audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MS audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MS audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MS audit doc"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MS audit doc"
        }
      },
      "MS-MA-MIBCBS": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MS audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MS audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MS audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MS audit doc"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MS audit doc"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MS audit doc"
        }
      },
      "MS-MA-UHC": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MS audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MS audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MS audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MS audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MS audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MS audit doc"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MS audit doc"
        }
      },
      "MS-MAC-NOVITAS": {
        "Botox": {
          "status": "",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "N/A - Medical Benefit",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        }
      },
      "MS-MCD-MAGNOLIA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MS audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Envolve Pharmacy Solutions national formulary; verify via payer portal"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MS audit doc"
        }
      },
      "MS-MCD-MOLINA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MS audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from CVS Caremark national formulary; verify via payer portal"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MS audit doc"
        }
      },
      "MS-MCD-MSDOM": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "State SPBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "State SPBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "State SPBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        }
      },
      "MS-MCD-TRUECARE": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "TrueCare PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "TrueCare PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "TrueCare PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        }
      },
      "MS-MCD-UHC": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MS audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MS audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MS audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MS audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MS audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MS audit doc"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MS audit doc"
        }
      },
      "MS-PARTB-NOVITAS": {
        "Botox": {
          "status": "",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        }
      },
      "MT-COM-ALLEG": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MT audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MT audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MT audit doc"
        },
        "Zavzpret": {
          "status": "",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Tier 2, QL 6 units/fill, 60 units/365 days"
        }
      },
      "MT-COM-BCBSMT": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MT audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Prime Therapeutics national formulary; verify via payer portal"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MT audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Prime Therapeutics national formulary; verify via payer portal"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Prime Therapeutics national formulary; verify via payer portal"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "30/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Prime Therapeutics national formulary; verify via payer portal"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Prime Therapeutics national formulary; verify via payer portal"
        }
      },
      "MT-COM-PACIFIC": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "MedImpact",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "MedImpact",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MT audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "MedImpact",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MT audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "MedImpact",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "MedImpact",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "MedImpact",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "MedImpact",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "MedImpact",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MT audit doc"
        }
      },
      "MT-COM-PACIFICSOURCE": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MT audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from CVS Caremark national formulary; verify via payer portal"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from CVS Caremark national formulary; verify via payer portal"
        },
        "Ubrelvy": {
          "status": "",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Tier 4"
        }
      },
      "MT-COM-UHC": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MT audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": ""
        }
      },
      "MT-MA-AETNACARE": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MT audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MT audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MT audit doc"
        }
      },
      "MT-MA-HUMANA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MT audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MT audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MT audit doc"
        }
      },
      "MT-MA-MTBCBS": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MT audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MT audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MT audit doc"
        }
      },
      "MT-MA-UHC": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MT audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MT audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from MT audit doc"
        }
      },
      "MT-MAC-NORIDIAN": {
        "Botox": {
          "status": "",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "N/A - Medical Benefit",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        }
      },
      "MT-MCD-DPHHS": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "MT Medicaid PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "MT Medicaid PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "MT Medicaid PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        },
        "Qulipta": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "30/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Preferred Agent"
        },
        "Zavzpret": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Non-Preferred"
        }
      },
      "MT-MCD-MTDPHHS": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "State SPBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "State SPBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "State SPBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        },
        "Qulipta": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Preferred Agent"
        },
        "Zavzpret": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Non-Preferred"
        }
      },
      "MT-PARTB-NORIDIAN": {
        "Botox": {
          "status": "",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        }
      },
      "NC-CHIP-HEALTHYBLUE": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "Medicare step therapy applies",
          "siteOfCare": "",
          "pbm": "Elevance PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NC audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Elevance PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NC audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Elevance PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NC audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "Medicare step therapy applies",
          "siteOfCare": "",
          "pbm": "Elevance PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NC audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Elevance PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NC audit doc"
        },
        "Qulipta": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Elevance PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NC audit doc"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Elevance PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NC audit doc"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Elevance PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NC audit doc"
        }
      },
      "NC-CHIP-UHC": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "Medicare step therapy applies",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NC audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NC audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NC audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "Medicare step therapy applies",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NC audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NC audit doc"
        },
        "Qulipta": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NC audit doc"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NC audit doc"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NC audit doc"
        }
      },
      "NC-CHIP-WELLCARE": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "Medicare step therapy applies",
          "siteOfCare": "",
          "pbm": "Centene PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NC audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Centene PBM",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Centene PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NC audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "Medicare step therapy applies",
          "siteOfCare": "",
          "pbm": "Centene PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NC audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Centene PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NC audit doc"
        },
        "Qulipta": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Centene PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NC audit doc"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Centene PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NC audit doc"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Centene PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NC audit doc"
        }
      },
      "NC-COM-AETNA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "Medicare step therapy applies",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NC audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NC audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "Medicare step therapy applies",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NC audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NC audit doc"
        },
        "Qulipta": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NC audit doc"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NC audit doc"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NC audit doc"
        }
      },
      "NC-COM-AMBET": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "Medicare step therapy applies",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NC audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NC audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "Medicare step therapy applies",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NC audit doc"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NC audit doc"
        }
      },
      "NC-COM-NCARBCBS": {
        "Qulipta": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "30/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NC audit doc | Remapped from NC-COM-BCBSNC"
        },
        "Aimovig": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "Medicare step therapy applies",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Botox": {
          "status": "Restricted",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Emgality": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "Medicare step therapy applies",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NC audit doc"
        }
      },
      "NC-COM-CIGNA": {
        "Aimovig": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "Medicare step therapy applies",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "Medicare step therapy applies",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NC audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "Medicare step therapy applies",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "Step within class: Nurtec",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NC audit doc"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NC audit doc"
        },
        "Zavzpret": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Tier 2 (Preferred Brand), PA Required"
        }
      },
      "NC-COM-UHC": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "Medicare step therapy applies",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NC audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "Medicare step therapy applies",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NC audit doc"
        },
        "Qulipta": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NC audit doc"
        },
        "Ubrelvy": {
          "status": "Restricted",
          "tier": "",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Vyepti": {
          "status": "Restricted",
          "tier": "",
          "qty": "",
          "stepInClass": "Fail Aimovig first",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": ""
        }
      },
      "NC-MA-AETNACARE": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "Medicare step therapy applies",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NC audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NC audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "Medicare step therapy applies",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NC audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NC audit doc"
        },
        "Qulipta": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NC audit doc"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NC audit doc"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NC audit doc"
        }
      },
      "NC-MA-CIGNA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "Medicare step therapy applies",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NC audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "Medicare step therapy applies",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NC audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NC audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "Medicare step therapy applies",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NC audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "Step within class: Nurtec",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NC audit doc"
        },
        "Qulipta": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NC audit doc"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NC audit doc"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NC audit doc"
        }
      },
      "NC-MA-HUMANA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "Medicare step therapy applies",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NC audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NC audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NC audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "Medicare step therapy applies",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NC audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NC audit doc"
        },
        "Qulipta": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NC audit doc"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NC audit doc"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NC audit doc"
        }
      },
      "NC-MA-NCBCBS": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "Medicare step therapy applies",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NC audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NC audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "Medicare step therapy applies",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NC audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NC audit doc"
        },
        "Qulipta": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NC audit doc"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NC audit doc"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NC audit doc"
        }
      },
      "NC-MA-UHC": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "Medicare step therapy applies",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NC audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NC audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NC audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "Medicare step therapy applies",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NC audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NC audit doc"
        },
        "Qulipta": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NC audit doc"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NC audit doc"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NC audit doc"
        }
      },
      "NC-MCD-AETNABETTER": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "Medicare step therapy applies",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NC audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NC audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "Medicare step therapy applies",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NC audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NC audit doc"
        },
        "Qulipta": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NC audit doc"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NC audit doc"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NC audit doc"
        }
      },
      "NC-MCD-AMERIHEALTH": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "Medicare step therapy applies",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NC audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NC audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "Medicare step therapy applies",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NC audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NC audit doc"
        },
        "Qulipta": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NC audit doc"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NC audit doc"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NC audit doc"
        }
      },
      "NC-MCD-CARCOMPLETE": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "Medicare step therapy applies",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NC audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NC audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "Medicare step therapy applies",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NC audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NC audit doc"
        },
        "Qulipta": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NC audit doc"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NC audit doc"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NC audit doc"
        }
      },
      "NC-MCD-DHB": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "Medicare step therapy applies",
          "siteOfCare": "",
          "pbm": "State-managed",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "Medicare step therapy applies",
          "siteOfCare": "",
          "pbm": "State-managed",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Botox": {
          "status": "",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "State-managed",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        },
        "Emgality": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "Medicare step therapy applies",
          "siteOfCare": "",
          "pbm": "State-managed",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "",
          "qty": "16/30 days",
          "stepInClass": "Step within class: Nurtec",
          "siteOfCare": "",
          "pbm": "State-managed",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "",
          "qty": "16/30 days",
          "stepInClass": "Medicare step therapy applies",
          "siteOfCare": "",
          "pbm": "State-managed",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "State-managed",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        }
      },
      "NC-MCD-HEALTHYBLUE": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "Medicare step therapy applies",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NC audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NC audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NC audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "Medicare step therapy applies",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NC audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NC audit doc"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NC audit doc"
        }
      },
      "NC-MCD-NDBCBS": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "Medicare step therapy applies",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NC audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NC audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "Medicare step therapy applies",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NC audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NC audit doc"
        },
        "Qulipta": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NC audit doc"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NC audit doc"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NC audit doc"
        }
      },
      "NC-MCD-NORIDIAN": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "Medicare step therapy applies",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NC audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NC audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "Medicare step therapy applies",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NC audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NC audit doc"
        },
        "Qulipta": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NC audit doc"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NC audit doc"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NC audit doc"
        }
      },
      "NC-MCD-SANFORD": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "Medicare step therapy applies",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NC audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NC audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NC audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "Medicare step therapy applies",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NC audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NC audit doc"
        },
        "Qulipta": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NC audit doc"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NC audit doc"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NC audit doc"
        }
      },
      "NC-MCD-UHC": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "Medicare step therapy applies",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NC audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NC audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NC audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "Medicare step therapy applies",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NC audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NC audit doc"
        },
        "Qulipta": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NC audit doc"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NC audit doc"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NC audit doc"
        }
      },
      "NC-MCD-WELLCARE": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "Medicare step therapy applies",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NC audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NC audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "Medicare step therapy applies",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NC audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NC audit doc"
        },
        "Qulipta": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NC audit doc"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NC audit doc"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NC audit doc"
        }
      },
      "NC-PARTB-PALMETTO": {
        "Botox": {
          "status": "",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "N/A - Medicare",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "N/A - Medicare",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        }
      },
      "ND-COM-BCBSND": {
        "Aimovig": {
          "status": "",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "BCBSND PBM",
          "confidence": "Gap-Manual-Review",
          "notes": "No audit data or PBM match; PBM=BCBSND PBM; requires manual verification"
        },
        "Ajovy": {
          "status": "",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "BCBSND PBM",
          "confidence": "Gap-Manual-Review",
          "notes": "No audit data or PBM match; PBM=BCBSND PBM; requires manual verification"
        },
        "Emgality": {
          "status": "",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "BCBSND PBM",
          "confidence": "Gap-Manual-Review",
          "notes": "No audit data or PBM match; PBM=BCBSND PBM; requires manual verification"
        },
        "Nurtec ODT": {
          "status": "",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "BCBSND PBM",
          "confidence": "Gap-Manual-Review",
          "notes": "No audit data or PBM match; PBM=BCBSND PBM; requires manual verification"
        },
        "Ubrelvy": {
          "status": "",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "BCBSND PBM",
          "confidence": "Gap-Manual-Review",
          "notes": "No audit data or PBM match; PBM=BCBSND PBM; requires manual verification"
        }
      },
      "ND-COM-MEDICA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "Step within class: Botox/Ubrelvy/Nurtec",
          "siteOfCare": "Physician Office",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from ND audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from ND audit doc"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from ND audit doc"
        }
      },
      "ND-COM-NDAKBCBS": {
        "Aimovig": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Prime Therapeutics national formulary; verify via payer portal"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Prime Therapeutics national formulary; verify via payer portal"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from ND audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Prime Therapeutics national formulary; verify via payer portal"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Prime Therapeutics national formulary; verify via payer portal"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Prime Therapeutics national formulary; verify via payer portal"
        }
      },
      "ND-COM-SANFORD": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Express Scripts national formulary; verify via payer portal"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Express Scripts national formulary; verify via payer portal"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Express Scripts national formulary; verify via payer portal"
        }
      },
      "ND-COM-UHC": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from OptumRx national formulary; verify via payer portal"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Zavzpret": {
          "status": "",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Tier 4 (PA, ST, QL)"
        }
      },
      "ND-MA-MEDICA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "Step within class: Botox/Ubrelvy/Nurtec",
          "siteOfCare": "Physician Office",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from ND audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from ND audit doc"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from ND audit doc"
        }
      },
      "ND-MA-NDBCBS": {
        "Aimovig": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from ND audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from ND audit doc"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from ND audit doc"
        }
      },
      "ND-MA-SANFORD": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from ND audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from ND audit doc"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from ND audit doc"
        }
      },
      "ND-MA-UHC": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from ND audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from ND audit doc"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from ND audit doc"
        }
      },
      "ND-MAC-NORIDIAN": {
        "Botox": {
          "status": "",
          "tier": "",
          "qty": "",
          "stepInClass": "Step within class: Botox/Ubrelvy/Nurtec",
          "siteOfCare": "Physician Office",
          "pbm": "N/A - Medical Benefit",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        }
      },
      "ND-MCD-DHS": {
        "Aimovig": {
          "status": "",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Acentra Health",
          "confidence": "Gap-Manual-Review",
          "notes": "No audit data or PBM match; PBM=Acentra Health; requires manual verification"
        },
        "Ajovy": {
          "status": "",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Acentra Health",
          "confidence": "Gap-Manual-Review",
          "notes": "No audit data or PBM match; PBM=Acentra Health; requires manual verification"
        },
        "Emgality": {
          "status": "",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Acentra Health",
          "confidence": "Gap-Manual-Review",
          "notes": "No audit data or PBM match; PBM=Acentra Health; requires manual verification"
        },
        "Nurtec ODT": {
          "status": "",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Acentra Health",
          "confidence": "Gap-Manual-Review",
          "notes": "No audit data or PBM match; PBM=Acentra Health; requires manual verification"
        },
        "Ubrelvy": {
          "status": "",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Acentra Health",
          "confidence": "Gap-Manual-Review",
          "notes": "No audit data or PBM match; PBM=Acentra Health; requires manual verification"
        },
        "Qulipta": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "30/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from ND audit doc | Remapped from ND-MCD-NDMEDIC"
        },
        "Zavzpret": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Non-Preferred"
        }
      },
      "ND-MCD-NDDHS": {
        "Aimovig": {
          "status": "",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "State SPBM",
          "confidence": "Gap-Manual-Review",
          "notes": "No audit data or PBM match; PBM=State SPBM; requires manual verification"
        },
        "Ajovy": {
          "status": "",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "State SPBM",
          "confidence": "Gap-Manual-Review",
          "notes": "No audit data or PBM match; PBM=State SPBM; requires manual verification"
        },
        "Emgality": {
          "status": "",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "State SPBM",
          "confidence": "Gap-Manual-Review",
          "notes": "No audit data or PBM match; PBM=State SPBM; requires manual verification"
        },
        "Nurtec ODT": {
          "status": "",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "State SPBM",
          "confidence": "Gap-Manual-Review",
          "notes": "No audit data or PBM match; PBM=State SPBM; requires manual verification"
        },
        "Ubrelvy": {
          "status": "",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "State SPBM",
          "confidence": "Gap-Manual-Review",
          "notes": "No audit data or PBM match; PBM=State SPBM; requires manual verification"
        },
        "Zavzpret": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Non-Preferred"
        }
      },
      "ND-PARTB-NORIDIAN": {
        "Botox": {
          "status": "",
          "tier": "",
          "qty": "",
          "stepInClass": "Step within class: Botox/Ubrelvy/Nurtec",
          "siteOfCare": "Physician Office",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        }
      },
      "NE-COM-AETNA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NE audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NE audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 1",
          "qty": "15/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NE audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 1",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NE audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NE audit doc"
        }
      },
      "NE-COM-AMBET": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NE audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NE audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 1",
          "qty": "15/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NE audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 1",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NE audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NE audit doc"
        }
      },
      "NE-COM-BCBSNE": {
        "Aimovig": {
          "status": "Non-Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Emgality": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Nurtec ODT": {
          "status": "",
          "tier": "Tier 2",
          "qty": "15/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ubrelvy": {
          "status": "",
          "tier": "Tier 2",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": ""
        }
      },
      "NE-COM-MEDICA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NE audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NE audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 1",
          "qty": "15/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NE audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 1",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NE audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Tier 1",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NE audit doc"
        }
      },
      "NE-COM-NEBBCBS": {
        "Aimovig": {
          "status": "Non-Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NE audit doc"
        },
        "Emgality": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": ""
        }
      },
      "NE-COM-UHC": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NE audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "30/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from OptumRx national formulary; verify via payer portal"
        },
        "Zavzpret": {
          "status": "Covered",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Covered / 1 oral triptan + 1 nasal triptan failure required / No concurrent use with other acute CGRPs"
        }
      },
      "NE-MA-AETNACARE": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NE audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NE audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 1",
          "qty": "15/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NE audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 1",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NE audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NE audit doc"
        }
      },
      "NE-MA-HUMANA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NE audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NE audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 1",
          "qty": "15/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NE audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 1",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NE audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NE audit doc"
        },
        "Zavzpret": {
          "status": "Covered",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Covered / Tier 3 / QL and PA required"
        }
      },
      "NE-MA-NEBCBS": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NE audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NE audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 1",
          "qty": "15/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NE audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 1",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NE audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NE audit doc"
        }
      },
      "NE-MA-UHC": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NE audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NE audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 1",
          "qty": "15/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NE audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 1",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NE audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NE audit doc"
        }
      },
      "NE-MCD-HEALTHYBLUE": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NE audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NE audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 1",
          "qty": "15/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NE audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 1",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NE audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NE audit doc"
        }
      },
      "NE-MCD-HERITAGE": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "NE Medicaid PBM",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "NE Medicaid PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        },
        "Botox": {
          "status": "",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "NE Medicaid PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "NE Medicaid PBM",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Nurtec ODT": {
          "status": "",
          "tier": "Tier 1",
          "qty": "15/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "NE Medicaid PBM",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ubrelvy": {
          "status": "Restricted",
          "tier": "Tier 1",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "NE Medicaid PBM",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Vyepti": {
          "status": "",
          "tier": "",
          "qty": "",
          "stepInClass": "Fail SC CGRP first",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "NE Medicaid PBM",
          "confidence": "Gap-Manual-Review",
          "notes": "No audit data or PBM match; PBM=NE Medicaid PBM; requires manual verification"
        },
        "Zavzpret": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Non-Preferred / Failure or contraindication to two triptans required"
        }
      },
      "NE-MCD-MOLINA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NE audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NE audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 1",
          "qty": "15/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NE audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 1",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NE audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NE audit doc"
        }
      },
      "NE-MCD-UHC": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NE audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NE audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 1",
          "qty": "15/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NE audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 1",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NE audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NE audit doc"
        },
        "Zavzpret": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Non-Preferred / Failure or contraindication to two triptans required"
        }
      },
      "NE-PARTB-WPS": {
        "Botox": {
          "status": "",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        }
      },
      "NH-CHIP-NHHF": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Envolve",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: physician-administered (onabotulinumtoxinA)"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Envolve",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: IV infusion (eptinezumab)"
        }
      },
      "NH-COM-AETNA": {
        "Aimovig": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: physician-administered (onabotulinumtoxinA)"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: IV infusion (eptinezumab)"
        }
      },
      "NH-COM-AMBETTER": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Centene PBM",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Centene PBM",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Centene PBM",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: physician-administered (onabotulinumtoxinA)"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Centene PBM",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Centene PBM",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Centene PBM",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Centene PBM",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Centene PBM",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: IV infusion (eptinezumab)"
        }
      },
      "NH-COM-ANTHEM": {
        "Aimovig": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CarelonRx",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CarelonRx",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Botox": {
          "status": "",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "CarelonRx",
          "confidence": "Gap-Manual-Review",
          "notes": "No audit data or PBM match; PBM=CarelonRx; requires manual verification; SOC default: physician-administered (onabotulinumtoxinA)"
        },
        "Emgality": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CarelonRx",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Nurtec ODT": {
          "status": "",
          "tier": "",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CarelonRx",
          "confidence": "Gap-Manual-Review",
          "notes": "No audit data or PBM match; PBM=CarelonRx; requires manual verification"
        },
        "Qulipta": {
          "status": "",
          "tier": "",
          "qty": "30/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CarelonRx",
          "confidence": "Gap-Manual-Review",
          "notes": "No audit data or PBM match; PBM=CarelonRx; requires manual verification"
        },
        "Ubrelvy": {
          "status": "",
          "tier": "",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CarelonRx",
          "confidence": "Gap-Manual-Review",
          "notes": "No audit data or PBM match; PBM=CarelonRx; requires manual verification"
        }
      },
      "NH-COM-CIGNA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: physician-administered (onabotulinumtoxinA)"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: IV infusion (eptinezumab)"
        },
        "Zavzpret": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Tier 2 (Preferred Brand)"
        }
      },
      "NH-COM-HARVARDPILGRIM": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ajovy": {
          "status": "Excluded",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Nurtec ODT": {
          "status": "",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ubrelvy": {
          "status": "",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": ""
        }
      },
      "NH-MA-AETNACARE": {
        "Aimovig": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: physician-administered (onabotulinumtoxinA)"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: IV infusion (eptinezumab)"
        }
      },
      "NH-MA-ELEV": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: physician-administered (onabotulinumtoxinA)"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: IV infusion (eptinezumab)"
        }
      },
      "NH-MA-HUMANA": {
        "Aimovig": {
          "status": "Not Covered",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Nonformulary (Not Covered)"
        },
        "Ajovy": {
          "status": "Not Covered",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Nonformulary (Not Covered)"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: physician-administered (onabotulinumtoxinA)"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Not Covered",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Nonformulary (Not Covered)"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Not Covered",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Nonformulary (Not Covered)"
        }
      },
      "NH-MA-UHC": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: physician-administered (onabotulinumtoxinA)"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: IV infusion (eptinezumab)"
        }
      },
      "NH-MAC-NGS": {
        "Botox": {
          "status": "",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "N/A - Medical Benefit",
          "confidence": "Gap-Manual-Review",
          "notes": "No audit data or PBM match; PBM=N/A - Medical Benefit; requires manual verification; SOC default: physician-administered (onabotulinumtoxinA)"
        }
      },
      "NH-MCD-AMERIHEALTH": {
        "Aimovig": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: physician-administered (onabotulinumtoxinA)"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: IV infusion (eptinezumab)"
        }
      },
      "NH-MCD-GRANITE": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Envolve Pharmacy Solutions national formulary; verify via payer portal"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Envolve Pharmacy Solutions national formulary; verify via payer portal"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Envolve Pharmacy Solutions national formulary; verify via payer portal"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Envolve Pharmacy Solutions national formulary; verify via payer portal"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Envolve Pharmacy Solutions national formulary; verify via payer portal"
        }
      },
      "NH-MCD-HEALTHYFAMILIES": {
        "Aimovig": {
          "status": "Non-Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Emgality": {
          "status": "Non-Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "9/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Envolve national formulary; verify via payer portal"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "9/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Envolve national formulary; verify via payer portal"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "30/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from  national formulary; verify via payer portal | Remapped from NH-MCD-NHMED (orphan resolved)"
        }
      },
      "NH-MCD-WELLSENSE": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: physician-administered (onabotulinumtoxinA)"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: IV infusion (eptinezumab)"
        },
        "Zavzpret": {
          "status": "",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Tier 2 (PA, QL required)"
        }
      },
      "NH-PARTB-NGS": {
        "Botox": {
          "status": "",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "",
          "confidence": "Gap-Manual-Review",
          "notes": "No audit data or PBM match; PBM=N/A; requires manual verification; SOC default: physician-administered (onabotulinumtoxinA)"
        }
      },
      "NJ-CHIP-AETNA": {
        "Aimovig": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NJ audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NJ audit doc"
        }
      },
      "NJ-CHIP-AMERIGROUP": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Elevance PBM",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Elevance PBM",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Elevance PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NJ audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Elevance PBM",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Elevance PBM",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Elevance PBM",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Elevance PBM",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Elevance PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NJ audit doc"
        }
      },
      "NJ-CHIP-UHC": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NJ audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NJ audit doc"
        }
      },
      "NJ-COM-AETNA": {
        "Aimovig": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from CVS Caremark national formulary; verify via payer portal"
        },
        "Ajovy": {
          "status": "Excluded",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Excluded (Non-formulary)"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NJ audit doc"
        },
        "Emgality": {
          "status": "Restricted",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from CVS Caremark national formulary; verify via payer portal"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from CVS Caremark national formulary; verify via payer portal"
        }
      },
      "NJ-COM-AETNA-CLUSTER": {
        "Emgality (Cluster)": {
          "status": "Restricted",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": ""
        }
      },
      "NJ-COM-AMERI": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Express Scripts national formulary; verify via payer portal"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Non-Preferred Drug (NPD)"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NJ audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Express Scripts national formulary; verify via payer portal"
        },
        "Nurtec ODT": {
          "status": "",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ubrelvy": {
          "status": "",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": ""
        }
      },
      "NJ-COM-CIGNA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NJ audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NJ audit doc"
        }
      },
      "NJ-COM-HORBCBS": {
        "Aimovig": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Prime Therapeutics national formulary; verify via payer portal"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Prime Therapeutics national formulary; verify via payer portal"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NJ audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Prime Therapeutics national formulary; verify via payer portal"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Prime Therapeutics national formulary; verify via payer portal"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Prime Therapeutics national formulary; verify via payer portal"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Prime Therapeutics national formulary; verify via payer portal"
        }
      },
      "NJ-COM-OSCAR": {
        "Aimovig": {
          "status": "",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Oscar PBM",
          "confidence": "Gap-Manual-Review",
          "notes": "No audit data or PBM match; PBM=Oscar PBM; requires manual verification"
        },
        "Ajovy": {
          "status": "",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Oscar PBM",
          "confidence": "Gap-Manual-Review",
          "notes": "No audit data or PBM match; PBM=Oscar PBM; requires manual verification"
        },
        "Emgality": {
          "status": "",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Oscar PBM",
          "confidence": "Gap-Manual-Review",
          "notes": "No audit data or PBM match; PBM=Oscar PBM; requires manual verification"
        },
        "Nurtec ODT": {
          "status": "",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Oscar PBM",
          "confidence": "Gap-Manual-Review",
          "notes": "No audit data or PBM match; PBM=Oscar PBM; requires manual verification"
        },
        "Ubrelvy": {
          "status": "",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Oscar PBM",
          "confidence": "Gap-Manual-Review",
          "notes": "No audit data or PBM match; PBM=Oscar PBM; requires manual verification"
        }
      },
      "NJ-COM-UHC": {
        "Aimovig": {
          "status": "Non-Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NJ audit doc"
        },
        "Emgality": {
          "status": "Non-Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from OptumRx national formulary; verify via payer portal"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "30/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from OptumRx national formulary; verify via payer portal"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from OptumRx national formulary; verify via payer portal"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from OptumRx national formulary; verify via payer portal"
        },
        "Zavzpret": {
          "status": "",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Tier 4 (Requires PA, ST, QL)"
        }
      },
      "NJ-MA-AETNACARE": {
        "Aimovig": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NJ audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NJ audit doc"
        }
      },
      "NJ-MA-CIGNA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NJ audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NJ audit doc"
        }
      },
      "NJ-MA-HORBCBS": {
        "Aimovig": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NJ audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NJ audit doc"
        }
      },
      "NJ-MA-HUMANA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NJ audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NJ audit doc"
        }
      },
      "NJ-MA-UHC": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NJ audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NJ audit doc"
        }
      },
      "NJ-MAC-NOVITAS": {
        "Botox": {
          "status": "",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "N/A - Medical Benefit",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        }
      },
      "NJ-MCD-AETNABETTER": {
        "Aimovig": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NJ audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NJ audit doc"
        }
      },
      "NJ-MCD-AMERIGROUP": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NJ audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NJ audit doc"
        }
      },
      "NJ-MCD-HORIZON": {
        "Aimovig": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Prime Therapeutics national formulary; verify via payer portal"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Prime Therapeutics national formulary; verify via payer portal"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NJ audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Prime Therapeutics national formulary; verify via payer portal"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Prime Therapeutics national formulary; verify via payer portal"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Prime Therapeutics national formulary; verify via payer portal"
        }
      },
      "NJ-MCD-MOLINA": {
        "Aimovig": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NJ audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NJ audit doc"
        }
      },
      "NJ-MCD-NJFC": {
        "Aimovig": {
          "status": "",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "State-managed",
          "confidence": "Gap-Manual-Review",
          "notes": "No audit data or PBM match; PBM=State-managed; requires manual verification"
        },
        "Ajovy": {
          "status": "",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "State-managed",
          "confidence": "Gap-Manual-Review",
          "notes": "No audit data or PBM match; PBM=State-managed; requires manual verification"
        },
        "Botox": {
          "status": "",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "State-managed",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        },
        "Emgality": {
          "status": "",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "State-managed",
          "confidence": "Gap-Manual-Review",
          "notes": "No audit data or PBM match; PBM=State-managed; requires manual verification"
        },
        "Nurtec ODT": {
          "status": "",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "State-managed",
          "confidence": "Gap-Manual-Review",
          "notes": "No audit data or PBM match; PBM=State-managed; requires manual verification"
        },
        "Ubrelvy": {
          "status": "",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "State-managed",
          "confidence": "Gap-Manual-Review",
          "notes": "No audit data or PBM match; PBM=State-managed; requires manual verification"
        }
      },
      "NJ-MCD-UHC": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NJ audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NJ audit doc"
        }
      },
      "NJ-MCD-WELLCARE": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NJ audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 5",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Tier 5 (Specialty Tier)"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NJ audit doc"
        }
      },
      "NJ-PARTB-NOVITAS": {
        "Vyepti": {
          "status": "",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "N/A - Medicare",
          "confidence": "Gap-Manual-Review",
          "notes": "No audit data or PBM match; PBM=N/A - Medicare; requires manual verification"
        }
      },
      "NM-CHIP-BCBSNM": {
        "Aimovig": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NM audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NM audit doc; SOC default: IV infusion (eptinezumab)"
        }
      },
      "NM-CHIP-WESTERNSKY": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Centene PBM",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Centene PBM",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Centene PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NM audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Centene PBM",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Centene PBM",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Centene PBM",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Centene PBM",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Centene PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NM audit doc; SOC default: IV infusion (eptinezumab)"
        }
      },
      "NM-COM-AMBET": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NM audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NM audit doc; SOC default: IV infusion (eptinezumab)"
        }
      },
      "NM-COM-BCBSNM": {
        "Aimovig": {
          "status": "",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ajovy": {
          "status": "",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Prime Therapeutics national formulary; verify via payer portal"
        },
        "Emgality": {
          "status": "",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Nurtec ODT": {
          "status": "",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Home/Freestanding Preferred",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NM audit doc"
        },
        "Emgality (Cluster)": {
          "status": "Restricted",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "| Remapped from NM-COM-BCBSNM-CLUSTER (cluster variant)"
        }
      },
      "NM-COM-MOLINA": {
        "Aimovig": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NM audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NM audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NM audit doc; SOC default: IV infusion (eptinezumab)"
        }
      },
      "NM-COM-PRESBY": {
        "Nurtec ODT": {
          "status": "",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ubrelvy": {
          "status": "",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": ""
        }
      },
      "NM-COM-PRESBYNM": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Express Scripts national formulary; verify via payer portal"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NM audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": ""
        }
      },
      "NM-COM-UHC": {
        "Aimovig": {
          "status": "",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ajovy": {
          "status": "",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Emgality": {
          "status": "",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "30/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from OptumRx national formulary; verify via payer portal"
        }
      },
      "NM-MA-HUMANA": {
        "Aimovig": {
          "status": "Excluded",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Non-Formulary (Excluded)"
        },
        "Ajovy": {
          "status": "Excluded",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Non-Formulary (Excluded)"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NM audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Excluded",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Non-Formulary (Excluded)"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Excluded",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Non-Formulary (Excluded)"
        }
      },
      "NM-MA-MOLINA": {
        "Aimovig": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NM audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NM audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NM audit doc; SOC default: IV infusion (eptinezumab)"
        }
      },
      "NM-MA-NMBCBS": {
        "Aimovig": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NM audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NM audit doc; SOC default: IV infusion (eptinezumab)"
        }
      },
      "NM-MA-PRESBYNM": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NM audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NM audit doc; SOC default: IV infusion (eptinezumab)"
        }
      },
      "NM-MA-UHC": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NM audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NM audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NM audit doc; SOC default: IV infusion (eptinezumab)"
        }
      },
      "NM-MAC-NOVITAS": {
        "Botox": {
          "status": "",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "N/A - Medical Benefit",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        }
      },
      "NM-MCD-MOLINA": {
        "Aimovig": {
          "status": "",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Molina PBM",
          "confidence": "Gap-Manual-Review",
          "notes": "No audit data or PBM match; PBM=Molina PBM; requires manual verification"
        },
        "Ajovy": {
          "status": "",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Molina PBM",
          "confidence": "Gap-Manual-Review",
          "notes": "No audit data or PBM match; PBM=Molina PBM; requires manual verification"
        },
        "Emgality": {
          "status": "",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Molina PBM",
          "confidence": "Gap-Manual-Review",
          "notes": "No audit data or PBM match; PBM=Molina PBM; requires manual verification"
        },
        "Qulipta": {
          "status": "",
          "tier": "",
          "qty": "30/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Molina PBM",
          "confidence": "Gap-Manual-Review",
          "notes": "No audit data or PBM match; PBM=Molina PBM; requires manual verification"
        }
      },
      "NM-MCD-NMBCBS": {
        "Aimovig": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NM audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NM audit doc; SOC default: IV infusion (eptinezumab)"
        }
      },
      "NM-MCD-PRESBYHEALTH": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Express Scripts national formulary; verify via payer portal"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Express Scripts national formulary; verify via payer portal"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Express Scripts national formulary; verify via payer portal"
        }
      },
      "NM-MCD-WESTERNSKY": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NM audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NM audit doc; SOC default: IV infusion (eptinezumab)"
        }
      },
      "NM-PARTB-NOVITAS": {
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NM audit doc"
        }
      },
      "NV-CHIP-ANTHEM": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Elevance PBM",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Elevance PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NV audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Elevance PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NV audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Elevance PBM",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Elevance PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NV audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Elevance PBM",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Elevance PBM",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Elevance PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NV audit doc"
        }
      },
      "NV-CHIP-HPN": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NV audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NV audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NV audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NV audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NV audit doc"
        }
      },
      "NV-CHIP-MOLINA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NV audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NV audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NV audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NV audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NV audit doc"
        }
      },
      "NV-COM-AETNA": {
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "30/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from CVS Caremark national formulary; verify via payer portal"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Non-preferred (targeted). Requires inadequate response or intolerance to both preferred products (Aimovig and Qulipta)."
        }
      },
      "NV-COM-AMBETTER": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NV audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NV audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NV audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NV audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NV audit doc"
        }
      },
      "NV-COM-ELEV": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from IngenioRx (Carelon) national formulary; verify via payer portal"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NV audit doc"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": ""
        }
      },
      "NV-COM-HEALTHNEV": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Excluded",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Excluded (E)"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NV audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NV audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NV audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NV audit doc"
        }
      },
      "NV-COM-HPN": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ajovy": {
          "status": "Excluded",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NV audit doc"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NV audit doc"
        }
      },
      "NV-COM-PROMPLAN": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NV audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NV audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NV audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NV audit doc"
        },
        "Zavzpret": {
          "status": "Excluded",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Excluded (Not Covered on National Preferred Formulary)"
        }
      },
      "NV-COM-UHC": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NV audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NV audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NV audit doc"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NV audit doc"
        },
        "Zavzpret": {
          "status": "",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Tier 4; requires PA, ST, and QL"
        }
      },
      "NV-MA-AETNACARE": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NV audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NV audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NV audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NV audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NV audit doc"
        }
      },
      "NV-MA-ELEV": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NV audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NV audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NV audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NV audit doc"
        }
      },
      "NV-MA-HUMANA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NV audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NV audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NV audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NV audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NV audit doc"
        }
      },
      "NV-MA-NEVHEALTH": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NV audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NV audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NV audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NV audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NV audit doc"
        }
      },
      "NV-MA-UHC": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NV audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NV audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NV audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NV audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NV audit doc"
        }
      },
      "NV-MAC-NORIDIAN": {
        "Botox": {
          "status": "",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "N/A - Medical Benefit",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        }
      },
      "NV-MCD-ANTHEM": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NV audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NV audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NV audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NV audit doc"
        }
      },
      "NV-MCD-HEALTHNEVADA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NV audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NV audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NV audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NV audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NV audit doc"
        }
      },
      "NV-MCD-MOLINA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NV audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NV audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NV audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NV audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NV audit doc"
        }
      },
      "NV-MCD-NVMEDICAID": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "State SPBM",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "State SPBM",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Botox": {
          "status": "",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "State SPBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "State SPBM",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "State SPBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "State SPBM",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Emgality (Cluster)": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from  national formulary; verify via payer portal | Remapped from NV-MCD-NVMEDICAID-CLUSTER (cluster variant)"
        },
        "Zavzpret": {
          "status": "Covered",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Covered with PA"
        }
      },
      "NV-MCD-SLIVERSUMMIT": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NV audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NV audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NV audit doc"
        }
      },
      "NV-MCD-SPDL": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx/CVS",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx/CVS",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx/CVS",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NV audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx/CVS",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx/CVS",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx/CVS",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Zavzpret": {
          "status": "Covered",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Covered with PA; Clinical Criteria updated by DUR Board to include Zavzpret under Serotonin 5-HT1 Receptor Agonists/Anti"
        }
      },
      "NV-PARTB-NORIDIAN": {
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NV audit doc"
        }
      },
      "NY-CHIP-FIDELIS": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Centene PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Centene PBM",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Tier 1",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Centene PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Centene PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Centene PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Centene PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Centene PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Centene PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        }
      },
      "NY-CHIP-MOLINA": {
        "Aimovig": {
          "status": "Non-Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Tier 1",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        }
      },
      "NY-COM-AETNA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from CVS Caremark national formulary; verify via payer portal"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Tier 1",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        },
        "Ubrelvy": {
          "status": "Restricted",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        }
      },
      "NY-COM-CIGNA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Tier 1",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        },
        "Zavzpret": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Tier 2 (Preferred Brand)"
        }
      },
      "NY-COM-ECELBCBS": {
        "Aimovig": {
          "status": "Non-Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Prime Therapeutics national formulary; verify via payer portal"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Tier 1",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        }
      },
      "NY-COM-EMBLEM": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Tier 1",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        }
      },
      "NY-COM-EMPIREBCBS": {
        "Qulipta": {
          "status": "",
          "tier": "Tier 2",
          "qty": "30/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "| Remapped from NY-COM-EMPIRE"
        },
        "Aimovig": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Tier 1",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": ""
        }
      },
      "NY-COM-OSCAR": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Tier 1",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        }
      },
      "NY-COM-UHC": {
        "Aimovig": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ajovy": {
          "status": "Excluded",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Tier 1",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        },
        "Emgality": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 2",
          "qty": "30/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from OptumRx national formulary; verify via payer portal"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "SOC Review Required",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        },
        "Zavzpret": {
          "status": "",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Tier 4 (Subject to PA, ST, QL)"
        }
      },
      "NY-MA-AETNACARE": {
        "Aimovig": {
          "status": "Non-Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Tier 1",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        }
      },
      "NY-MA-ECELBCBS": {
        "Aimovig": {
          "status": "Non-Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Tier 1",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        }
      },
      "NY-MA-EMBLEM": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Tier 1",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        }
      },
      "NY-MA-EMPIREBCBS": {
        "Botox": {
          "status": "Preferred",
          "tier": "Tier 1",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        }
      },
      "NY-MA-FIDELIS": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Tier 1",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        }
      },
      "NY-MA-HEALTHFIRST": {
        "Aimovig": {
          "status": "Non-Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Tier 1",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        }
      },
      "NY-MA-HUMANA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Tier 1",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        }
      },
      "NY-MA-UHC": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Tier 1",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        }
      },
      "NY-MAC-NGS": {
        "Botox": {
          "status": "",
          "tier": "Tier 1",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "N/A - Medical Benefit",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        }
      },
      "NY-MCD-AFFINITY": {
        "Aimovig": {
          "status": "Non-Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Tier 1",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        }
      },
      "NY-MCD-EMPIREBCBS": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Tier 1",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        }
      },
      "NY-MCD-FIDELIS": {
        "Botox": {
          "status": "Preferred",
          "tier": "Tier 1",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 2",
          "qty": "30/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Non-HOPD Preferred",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        },
        "Emgality (Cluster)": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc | Remapped from NY-MCD-FIDELIS-CLUSTER (cluster variant)"
        }
      },
      "NY-MCD-HEALTHFIRST": {
        "Aimovig": {
          "status": "Non-Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Tier 1",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        }
      },
      "NY-MCD-METROPLUS": {
        "Aimovig": {
          "status": "Non-Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Tier 1",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        }
      },
      "NY-MCD-MOLINA": {
        "Aimovig": {
          "status": "Non-Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Tier 1",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        }
      },
      "NY-MCD-MVPHEALTH": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Tier 1",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        }
      },
      "NY-MCD-NYRX": {
        "Aimovig": {
          "status": "Non-Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "Step through preferred CGRP",
          "siteOfCare": "",
          "pbm": "Magellan Rx (State Contract)",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "Step through preferred CGRP",
          "siteOfCare": "",
          "pbm": "Magellan Rx (State Contract)",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "Step through preferred CGRP",
          "siteOfCare": "",
          "pbm": "Magellan Rx (State Contract)",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Magellan Rx (State Contract)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        },
        "Qulipta": {
          "status": "",
          "tier": "Tier 2",
          "qty": "30/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Magellan Rx (State Contract)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        },
        "Ubrelvy": {
          "status": "",
          "tier": "Tier 3",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Magellan Rx (State Contract)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        },
        "Emgality (Cluster)": {
          "status": "Restricted",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "| Remapped from NY-MCD-NYRX-CLUSTER (cluster variant)"
        },
        "Zavzpret": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Non-Preferred (Requires CC/ST)"
        }
      },
      "NY-MCD-UHC": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Tier 1",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        }
      },
      "NY-MCD-WELLCARE": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Tier 1",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from NY audit doc"
        }
      },
      "NY-PARTB-NGS": {
        "Botox": {
          "status": "",
          "tier": "Tier 1",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "N/A - Medicare",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "N/A - Medicare",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        }
      },
      "OH-CHIP-BUCKEYE": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Centene PBM",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "Step within class: Ajovy/Emgality",
          "siteOfCare": "",
          "pbm": "Centene PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OH audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "Medicare: Botox/CGRP step (Part B/D split)",
          "siteOfCare": "HOPD",
          "pbm": "Centene PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OH audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Centene PBM",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "18/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Centene PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OH audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "Fail Emgality first",
          "siteOfCare": "",
          "pbm": "Centene PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OH audit doc"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "10/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Centene PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OH audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Centene PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OH audit doc"
        }
      },
      "OH-CHIP-MOLINA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OH audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "Step within class: Ajovy/Emgality",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OH audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "Medicare: Botox/CGRP step (Part B/D split)",
          "siteOfCare": "HOPD",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OH audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "18/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OH audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "Fail Emgality first",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OH audit doc"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "10/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OH audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OH audit doc"
        }
      },
      "OH-CHIP-UHC": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "Step within class: Ajovy/Emgality",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OH audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "Medicare: Botox/CGRP step (Part B/D split)",
          "siteOfCare": "HOPD",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OH audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "18/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OH audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "Fail Emgality first",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OH audit doc"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "10/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OH audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OH audit doc"
        }
      },
      "OH-COM-AETNA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OH audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "Step within class: Ajovy/Emgality",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OH audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "Medicare: Botox/CGRP step (Part B/D split)",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OH audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "18/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OH audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "Fail Emgality first",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OH audit doc"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "10/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OH audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OH audit doc"
        }
      },
      "OH-COM-CIGNA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "Step within class: Ajovy/Emgality",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OH audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "Medicare: Botox/CGRP step (Part B/D split)",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OH audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "18/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OH audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "Fail Emgality first",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OH audit doc"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "10/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OH audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OH audit doc"
        }
      },
      "OH-COM-ELEV": {
        "Aimovig": {
          "status": "Non-Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "Step within class: Ajovy/Emgality",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "Medicare: Botox/CGRP step (Part B/D split)",
          "siteOfCare": "HOPD",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OH audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Nurtec ODT": {
          "status": "",
          "tier": "Tier 2",
          "qty": "18/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "Step through preferred CGRP",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from IngenioRx (Carelon) national formulary; verify via payer portal"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "10/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from IngenioRx (Carelon) national formulary; verify via payer portal"
        }
      },
      "OH-COM-MEDMUTUAL": {
        "Aimovig": {
          "status": "Non-Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "Step within class: Ajovy/Emgality",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "Medicare: Botox/CGRP step (Part B/D split)",
          "siteOfCare": "HOPD",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OH audit doc"
        },
        "Emgality": {
          "status": "Non-Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Nurtec ODT": {
          "status": "",
          "tier": "Tier 2",
          "qty": "10/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ubrelvy": {
          "status": "",
          "tier": "Tier 3",
          "qty": "10/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "SOC Review Required",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OH audit doc"
        }
      },
      "OH-COM-MOLINA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OH audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "Step within class: Ajovy/Emgality",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OH audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "Medicare: Botox/CGRP step (Part B/D split)",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OH audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "18/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OH audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "Fail Emgality first",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OH audit doc"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "10/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OH audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OH audit doc"
        }
      },
      "OH-COM-UHC": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "Step within class: Ajovy/Emgality",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "Medicare: Botox/CGRP step (Part B/D split)",
          "siteOfCare": "HOPD",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OH audit doc"
        },
        "Emgality": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "18/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OH audit doc"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "10/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Non-HOPD Preferred",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from OptumRx national formulary; verify via payer portal"
        },
        "Zavzpret": {
          "status": "",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Tier 4 (Subject to PA, ST, QL)"
        }
      },
      "OH-MA-AETNACARE": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OH audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "Step within class: Ajovy/Emgality",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OH audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "Medicare: Botox/CGRP step (Part B/D split)",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OH audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "18/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OH audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "Fail Emgality first",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OH audit doc"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "10/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OH audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OH audit doc"
        }
      },
      "OH-MA-CARESOURCE": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "Step within class: Ajovy/Emgality",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OH audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "Medicare: Botox/CGRP step (Part B/D split)",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OH audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "18/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OH audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "Fail Emgality first",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OH audit doc"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "10/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OH audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OH audit doc"
        }
      },
      "OH-MA-ELEV": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "Step within class: Ajovy/Emgality",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OH audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "Medicare: Botox/CGRP step (Part B/D split)",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OH audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "18/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OH audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "Fail Emgality first",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OH audit doc"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "10/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OH audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OH audit doc"
        }
      },
      "OH-MA-HUMANA": {
        "Aimovig": {
          "status": "Not Covered",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Nonformulary (Not Covered)"
        },
        "Ajovy": {
          "status": "Not Covered",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "Step within class: Ajovy/Emgality",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Nonformulary (Not Covered)"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "Medicare: Botox/CGRP step (Part B/D split)",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OH audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Tier 4"
        },
        "Nurtec ODT": {
          "status": "Not Covered",
          "tier": "Tier 4",
          "qty": "18/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Nonformulary (Not Covered)"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "Fail Emgality first",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OH audit doc"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "10/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Tier 3"
        },
        "Vyepti": {
          "status": "Not Covered",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Nonformulary (Not Covered)"
        }
      },
      "OH-MA-MUTUALOHIO": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "Step within class: Ajovy/Emgality",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OH audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "Medicare: Botox/CGRP step (Part B/D split)",
          "siteOfCare": "HOPD",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OH audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "18/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OH audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "Fail Emgality first",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OH audit doc"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "10/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OH audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OH audit doc"
        }
      },
      "OH-MA-UHC": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "Step within class: Ajovy/Emgality",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OH audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "Medicare: Botox/CGRP step (Part B/D split)",
          "siteOfCare": "HOPD",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OH audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "18/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OH audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "Fail Emgality first",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OH audit doc"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "10/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OH audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OH audit doc"
        }
      },
      "OH-MCD-AETNABETTER": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OH audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "Step within class: Ajovy/Emgality",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OH audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "Medicare: Botox/CGRP step (Part B/D split)",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OH audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "18/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OH audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "Fail Emgality first",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OH audit doc"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "10/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OH audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OH audit doc"
        }
      },
      "OH-MCD-BUCKEYE": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Envolve Pharmacy Solutions national formulary; verify via payer portal"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "Step within class: Ajovy/Emgality",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OH audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "Medicare: Botox/CGRP step (Part B/D split)",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OH audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Envolve Pharmacy Solutions national formulary; verify via payer portal"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "18/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OH audit doc"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "10/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OH audit doc"
        },
        "Emgality (Cluster)": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from  national formulary; verify via payer portal | Remapped from OH-MCD-BUCKEYE-CLUSTER (cluster variant)"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "30/30 days",
          "stepInClass": "Fail Emgality first",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OH audit doc | Remapped from OH-MCD-UPDL"
        }
      },
      "OH-MCD-CARESOURCE": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Express Scripts national formulary; verify via payer portal"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "Step within class: Ajovy/Emgality",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OH audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "Medicare: Botox/CGRP step (Part B/D split)",
          "siteOfCare": "Physician Office",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OH audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Express Scripts national formulary; verify via payer portal"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "18/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OH audit doc"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "10/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OH audit doc"
        }
      },
      "OH-MCD-GAINWELL": {
        "Aimovig": {
          "status": "Non-Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Gainwell Technologies (SPBM)",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "Step within class: Ajovy/Emgality",
          "siteOfCare": "",
          "pbm": "Gainwell Technologies (SPBM)",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Emgality": {
          "status": "Non-Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Gainwell Technologies (SPBM)",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Nurtec ODT": {
          "status": "",
          "tier": "Tier 4",
          "qty": "18/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Gainwell Technologies (SPBM)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        },
        "Qulipta": {
          "status": "Restricted",
          "tier": "",
          "qty": "",
          "stepInClass": "Fail Emgality first",
          "siteOfCare": "",
          "pbm": "Gainwell Technologies (SPBM)",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ubrelvy": {
          "status": "",
          "tier": "Tier 4",
          "qty": "18/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Gainwell Technologies (SPBM)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        },
        "Zavzpret": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Non-Preferred"
        }
      },
      "OH-MCD-MOLINA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OH audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "Step within class: Ajovy/Emgality",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OH audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "Medicare: Botox/CGRP step (Part B/D split)",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OH audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "18/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OH audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "Fail Emgality first",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OH audit doc"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "10/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OH audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OH audit doc"
        }
      },
      "OH-MCD-PARAMOUNT": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "Step within class: Ajovy/Emgality",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OH audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "Medicare: Botox/CGRP step (Part B/D split)",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OH audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "18/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OH audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "Fail Emgality first",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OH audit doc"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "10/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OH audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OH audit doc"
        }
      },
      "OH-MCD-UHC": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "Step within class: Ajovy/Emgality",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OH audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "Medicare: Botox/CGRP step (Part B/D split)",
          "siteOfCare": "HOPD",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OH audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "18/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OH audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "Fail Emgality first",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OH audit doc"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "10/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OH audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OH audit doc"
        }
      },
      "OH-PARTB-CGS": {
        "Botox": {
          "status": "",
          "tier": "",
          "qty": "",
          "stepInClass": "Medicare: Botox/CGRP step (Part B/D split)",
          "siteOfCare": "HOPD",
          "pbm": "N/A - Medicare",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        },
        "Vyepti": {
          "status": "",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Non-HOPD Preferred",
          "pbm": "N/A - Medicare",
          "confidence": "Gap-Manual-Review",
          "notes": "No audit data or PBM match; PBM=N/A - Medicare; requires manual verification"
        }
      },
      "OK-COM-AETNA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OK audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OK audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from CVS Caremark national formulary; verify via payer portal"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OK audit doc"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from CVS Caremark national formulary; verify via payer portal"
        }
      },
      "OK-COM-AMBET": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OK audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OK audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OK audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OK audit doc"
        }
      },
      "OK-COM-BCBSOK": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OK audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OK audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OK audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Prime Therapeutics national formulary; verify via payer portal"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Prime Therapeutics national formulary; verify via payer portal"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OK audit doc"
        }
      },
      "OK-COM-BCBSOK-CLUSTER": {
        "Emgality (Cluster)": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from  national formulary; verify via payer portal"
        }
      },
      "OK-COM-COMMCARE": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OK audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OK audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OK audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OK audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OK audit doc"
        }
      },
      "OK-COM-UHC": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from OptumRx national formulary; verify via payer portal"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OK audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from OptumRx national formulary; verify via payer portal"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "30/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from OptumRx national formulary; verify via payer portal"
        }
      },
      "OK-MA-AETNACARE": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OK audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OK audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OK audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OK audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OK audit doc"
        }
      },
      "OK-MA-HUMANA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OK audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OK audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OK audit doc"
        }
      },
      "OK-MA-OKBCBS": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OK audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OK audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OK audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OK audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OK audit doc"
        }
      },
      "OK-MA-UHC": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OK audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OK audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OK audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OK audit doc"
        }
      },
      "OK-MCD-AETNA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OK audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OK audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OK audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from CVS Caremark national formulary; verify via payer portal"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Preferred Agent"
        }
      },
      "OK-MCD-AETNABETTER": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OK audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OK audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OK audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OK audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OK audit doc"
        }
      },
      "OK-MCD-COMPLETE": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Centene PBM",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Centene PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OK audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Centene PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OK audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Centene PBM",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Centene PBM",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Centene PBM",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Centene PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OK audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Centene PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OK audit doc"
        }
      },
      "OK-MCD-HUMANA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Humana Pharmacy Solutions national formulary; verify via payer portal"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OK audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Humana Pharmacy Solutions national formulary; verify via payer portal"
        }
      },
      "OK-MCD-OKCOMPLETE": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Envolve Pharmacy Solutions national formulary; verify via payer portal"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OK audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Envolve Pharmacy Solutions national formulary; verify via payer portal"
        }
      },
      "OK-MCD-UHC": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OK audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OK audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OK audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OK audit doc"
        }
      },
      "OK-PARTB-NOVITAS": {
        "Botox": {
          "status": "",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        }
      },
      "OR-CHIP-PACIFICSOURCE": {
        "Aimovig": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OR audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OR audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OR audit doc"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 1",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OR audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 1",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OR audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Tier 1",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OR audit doc"
        }
      },
      "OR-CHIP-TRILLIUM": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Centene PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OR audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Centene PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OR audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Centene PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OR audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Centene PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OR audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 1",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Centene PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OR audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Centene PBM",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 1",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Centene PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OR audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Tier 1",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Centene PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OR audit doc"
        }
      },
      "OR-COM-CAMBIA": {
        "Aimovig": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Prime Therapeutics national formulary; verify via payer portal"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OR audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OR audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OR audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 1",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OR audit doc"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 1",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OR audit doc"
        }
      },
      "OR-COM-KAISER": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Kaiser Permanente (Internal)/MedImpact",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OR audit doc"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Kaiser Permanente (Internal)/MedImpact",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Kaiser Permanente (Internal)/MedImpact national formulary; verify via payer portal"
        },
        "Botox": {
          "status": "",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Kaiser Permanente (Internal)/MedImpact",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Kaiser Permanente (Internal)/MedImpact",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OR audit doc"
        }
      },
      "OR-COM-MODA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "MedImpact",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OR audit doc"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "MedImpact",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from MedImpact national formulary; verify via payer portal"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "MedImpact",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OR audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 1",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "MedImpact",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OR audit doc"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 1",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "MedImpact",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OR audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Tier 1",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "MedImpact",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OR audit doc"
        },
        "Emgality (Cluster)": {
          "status": "Restricted",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "| Remapped from OR-COM-MODA-CLUSTER (cluster variant)"
        }
      },
      "OR-COM-PACIFIC": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "MedImpact",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OR audit doc"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "MedImpact",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "MedImpact",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OR audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "MedImpact",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OR audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 1",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "MedImpact",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OR audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "MedImpact",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 1",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "MedImpact",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OR audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Tier 1",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "MedImpact",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OR audit doc"
        }
      },
      "OR-COM-PROMPLAN": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OR audit doc"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OR audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OR audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 1",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OR audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 1",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OR audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Tier 1",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OR audit doc"
        }
      },
      "OR-COM-PROVIDENCE": {
        "Aimovig": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Providence PBM",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Providence PBM",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Emgality": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Providence PBM",
          "confidence": "Audit-Derived",
          "notes": ""
        }
      },
      "OR-COM-REGENCE": {
        "Aimovig": {
          "status": "",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Regence PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        },
        "Ajovy": {
          "status": "",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Regence PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        },
        "Emgality": {
          "status": "",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Regence PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        },
        "Nurtec ODT": {
          "status": "",
          "tier": "Tier 1",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Regence PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        },
        "Qulipta": {
          "status": "",
          "tier": "",
          "qty": "30/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Regence PBM",
          "confidence": "Gap-Manual-Review",
          "notes": "No audit data or PBM match; PBM=Regence PBM; requires manual verification"
        },
        "Ubrelvy": {
          "status": "Restricted",
          "tier": "Tier 1",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Regence PBM",
          "confidence": "Audit-Derived",
          "notes": ""
        }
      },
      "OR-COM-UHC": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OR audit doc"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OR audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OR audit doc"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 1",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OR audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 1",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OR audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Tier 1",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OR audit doc"
        }
      },
      "OR-MA-AETNACARE": {
        "Aimovig": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OR audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OR audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OR audit doc"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 1",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OR audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 1",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OR audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Tier 1",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OR audit doc"
        }
      },
      "OR-MA-HUMANA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OR audit doc"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OR audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OR audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 1",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OR audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 1",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OR audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Tier 1",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OR audit doc"
        }
      },
      "OR-MA-KAISER": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Kaiser Permanente (Internal)/MedImpact",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OR audit doc"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Kaiser Permanente (Internal)/MedImpact",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Kaiser Permanente (Internal)/MedImpact",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OR audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Kaiser Permanente (Internal)/MedImpact",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OR audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 1",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Kaiser Permanente (Internal)/MedImpact",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OR audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Kaiser Permanente (Internal)/MedImpact",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 1",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Kaiser Permanente (Internal)/MedImpact",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OR audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Tier 1",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Kaiser Permanente (Internal)/MedImpact",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OR audit doc"
        }
      },
      "OR-MA-MODA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "MedImpact",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OR audit doc"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "MedImpact",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "MedImpact",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OR audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "MedImpact",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OR audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 1",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "MedImpact",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OR audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "MedImpact",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 1",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "MedImpact",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OR audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Tier 1",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "MedImpact",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OR audit doc"
        }
      },
      "OR-MA-PROVHEALTH": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OR audit doc"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OR audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OR audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 1",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OR audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 1",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OR audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Tier 1",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OR audit doc"
        }
      },
      "OR-MA-UHC": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OR audit doc"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OR audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OR audit doc"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 1",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OR audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 1",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OR audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Tier 1",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OR audit doc"
        }
      },
      "OR-MCD-ALLCARE": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "MedImpact",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OR audit doc"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "MedImpact",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "MedImpact",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OR audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "MedImpact",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OR audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 1",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "MedImpact",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OR audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "MedImpact",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 1",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "MedImpact",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OR audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Tier 1",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "MedImpact",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OR audit doc"
        }
      },
      "OR-MCD-HEALTHSHARE": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OR audit doc"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OR audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OR audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 1",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OR audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 1",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OR audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Tier 1",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OR audit doc"
        }
      },
      "OR-MCD-PACIFIC": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "MedImpact",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OR audit doc"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "MedImpact",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "MedImpact",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OR audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "MedImpact",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OR audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 1",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "MedImpact",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OR audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "MedImpact",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 1",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "MedImpact",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OR audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Tier 1",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "MedImpact",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OR audit doc"
        }
      },
      "OR-MCD-TRILLIUM": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OR audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OR audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OR audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OR audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 1",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OR audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 1",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OR audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Tier 1",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OR audit doc"
        }
      },
      "OR-MCD-UMPQUA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "MedImpact",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OR audit doc"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "MedImpact",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "MedImpact",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OR audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "MedImpact",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OR audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 1",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "MedImpact",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OR audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "MedImpact",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 1",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "MedImpact",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OR audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Tier 1",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "MedImpact",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OR audit doc"
        }
      },
      "OR-PARTB-NORIDIAN": {
        "Botox": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from OR audit doc"
        }
      },
      "PA-CHIP-AETNA": {
        "Aimovig": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from PA audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from PA audit doc"
        }
      },
      "PA-COM-AETNA": {
        "Aimovig": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from PA audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from PA audit doc"
        }
      },
      "PA-COM-GEISINGER": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from PA audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from PA audit doc"
        }
      },
      "PA-COM-HIGHBCBS": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Express Scripts national formulary; verify via payer portal"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Express Scripts national formulary; verify via payer portal"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Express Scripts national formulary; verify via payer portal"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Express Scripts national formulary; verify via payer portal"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "30/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Express Scripts national formulary; verify via payer portal"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Express Scripts national formulary; verify via payer portal"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Express Scripts national formulary; verify via payer portal"
        },
        "Emgality (Cluster)": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from  national formulary; verify via payer portal | Remapped from PA-COM-HIGHBCBS-CLUSTER (cluster variant)"
        },
        "Zavzpret": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Preferred"
        }
      },
      "PA-COM-IBX": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Express Scripts national formulary; verify via payer portal"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Express Scripts national formulary; verify via payer portal"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from PA audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Express Scripts national formulary; verify via payer portal"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Express Scripts national formulary; verify via payer portal"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "30/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Express Scripts national formulary; verify via payer portal"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Express Scripts national formulary; verify via payer portal"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Express Scripts national formulary; verify via payer portal"
        }
      },
      "PA-COM-UHC": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from PA audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from PA audit doc"
        }
      },
      "PA-COM-UPMC": {
        "Aimovig": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from CVS Caremark national formulary; verify via payer portal"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from CVS Caremark national formulary; verify via payer portal"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from PA audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from CVS Caremark national formulary; verify via payer portal"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from CVS Caremark national formulary; verify via payer portal"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from CVS Caremark national formulary; verify via payer portal"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from CVS Caremark national formulary; verify via payer portal"
        }
      },
      "PA-MA-AETNACARE": {
        "Aimovig": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from PA audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from PA audit doc"
        }
      },
      "PA-MA-GEISINGER": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from PA audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from PA audit doc"
        }
      },
      "PA-MA-HIGHMARK": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from PA audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from PA audit doc"
        }
      },
      "PA-MA-HUMANA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from PA audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from PA audit doc"
        }
      },
      "PA-MA-UHC": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from PA audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from PA audit doc"
        }
      },
      "PA-MA-UPMCHEALTH": {
        "Aimovig": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from PA audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from PA audit doc"
        }
      },
      "PA-MAC-NOVITAS": {
        "Botox": {
          "status": "",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "N/A - Medicare",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        },
        "Vyepti": {
          "status": "",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "N/A - Medicare",
          "confidence": "Gap-Manual-Review",
          "notes": "No audit data or PBM match; PBM=N/A - Medicare; requires manual verification"
        }
      },
      "PA-MCD-AETNABETTER": {
        "Aimovig": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from PA audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from PA audit doc"
        }
      },
      "PA-MCD-AMERIHEALTH": {
        "Aimovig": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from CVS Caremark national formulary; verify via payer portal"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from CVS Caremark national formulary; verify via payer portal"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from PA audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from CVS Caremark national formulary; verify via payer portal"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from CVS Caremark national formulary; verify via payer portal"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from CVS Caremark national formulary; verify via payer portal"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "30/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from  national formulary; verify via payer portal | Remapped from PA-MCD-PADHS"
        }
      },
      "PA-MCD-FFS": {
        "Aimovig": {
          "status": "",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "PA DHS",
          "confidence": "Gap-Manual-Review",
          "notes": "No audit data or PBM match; PBM=PA DHS; requires manual verification"
        },
        "Ajovy": {
          "status": "",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "PA DHS",
          "confidence": "Gap-Manual-Review",
          "notes": "No audit data or PBM match; PBM=PA DHS; requires manual verification"
        },
        "Botox": {
          "status": "",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "PA DHS",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        },
        "Emgality": {
          "status": "",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "PA DHS",
          "confidence": "Gap-Manual-Review",
          "notes": "No audit data or PBM match; PBM=PA DHS; requires manual verification"
        },
        "Nurtec ODT": {
          "status": "",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "PA DHS",
          "confidence": "Gap-Manual-Review",
          "notes": "No audit data or PBM match; PBM=PA DHS; requires manual verification"
        },
        "Ubrelvy": {
          "status": "",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "PA DHS",
          "confidence": "Gap-Manual-Review",
          "notes": "No audit data or PBM match; PBM=PA DHS; requires manual verification"
        }
      },
      "PA-MCD-GATEWAYHEALTH": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from PA audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from PA audit doc"
        }
      },
      "PA-MCD-GEISINGER": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from PA audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from PA audit doc"
        }
      },
      "PA-MCD-KEYSTONEFIRST": {
        "Aimovig": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from PA audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from PA audit doc"
        }
      },
      "PA-MCD-PAWELLNESS": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from PA audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from PA audit doc"
        }
      },
      "PA-MCD-UHC": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from PA audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from PA audit doc"
        }
      },
      "PA-MCD-UPMCHEALTH": {
        "Aimovig": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from CVS Caremark national formulary; verify via payer portal"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from CVS Caremark national formulary; verify via payer portal"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from PA audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from CVS Caremark national formulary; verify via payer portal"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from CVS Caremark national formulary; verify via payer portal"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from CVS Caremark national formulary; verify via payer portal"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from CVS Caremark national formulary; verify via payer portal"
        }
      },
      "RI-CHIP-UHC": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: physician-administered (onabotulinumtoxinA)"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from RI audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from RI audit doc"
        }
      },
      "RI-COM-AETNA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from RI audit doc"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from RI audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: physician-administered (onabotulinumtoxinA)"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from RI audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from RI audit doc"
        }
      },
      "RI-COM-BCBSRI": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from RI audit doc"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from RI audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Prime Therapeutics national formulary; verify via payer portal"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from RI audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "30/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Prime Therapeutics national formulary; verify via payer portal"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from RI audit doc"
        }
      },
      "RI-COM-RIBCBS": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from RI audit doc"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from RI audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Prime Therapeutics national formulary; verify via payer portal; SOC default: physician-administered (onabotulinumtoxinA)"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Prime Therapeutics national formulary; verify via payer portal"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from RI audit doc"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from RI audit doc"
        }
      },
      "RI-COM-RINEIGH": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from RI audit doc"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from RI audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: physician-administered (onabotulinumtoxinA)"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from RI audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from RI audit doc"
        }
      },
      "RI-COM-TUFTS": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Express Scripts national formulary; verify via payer portal"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Express Scripts national formulary; verify via payer portal"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Express Scripts national formulary; verify via payer portal"
        }
      },
      "RI-COM-UHC": {
        "Aimovig": {
          "status": "Non-Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Emgality": {
          "status": "Non-Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": ""
        }
      },
      "RI-MA-HUMANA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: physician-administered (onabotulinumtoxinA)"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from RI audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from RI audit doc"
        }
      },
      "RI-MA-RIBCBS": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from RI audit doc"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from RI audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: physician-administered (onabotulinumtoxinA)"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from RI audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from RI audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from RI audit doc"
        }
      },
      "RI-MA-TUFTS": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: physician-administered (onabotulinumtoxinA)"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from RI audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from RI audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from RI audit doc"
        }
      },
      "RI-MA-UHC": {
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "Medicare step therapy applies",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from RI audit doc"
        }
      },
      "RI-MAC-NOVITAS": {
        "Botox": {
          "status": "",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "N/A - Medical Benefit",
          "confidence": "Gap-Manual-Review",
          "notes": "No audit data or PBM match; PBM=N/A - Medical Benefit; requires manual verification; SOC default: physician-administered (onabotulinumtoxinA)"
        }
      },
      "RI-MCD-NHPRI": {
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "NHPRI PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "NHPRI PBM",
          "confidence": "Audit-Derived",
          "notes": ""
        }
      },
      "RI-MCD-RINEIGH": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from RI audit doc"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from RI audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from CVS Caremark national formulary; verify via payer portal"
        }
      },
      "RI-MCD-UHC": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: physician-administered (onabotulinumtoxinA)"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from RI audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from RI audit doc"
        }
      },
      "RI-PARTB-NGS": {
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Site of Care Review Required",
          "pbm": "",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from  national formulary; verify via payer portal"
        }
      },
      "SC-CHIP-MOLINA": {
        "Aimovig": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from SC audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from SC audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from SC audit doc"
        }
      },
      "SC-COM-AETNA": {
        "Aimovig": {
          "status": "Excluded",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Excluded"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from SC audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from SC audit doc"
        },
        "Zavzpret": {
          "status": "Excluded",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Excluded"
        }
      },
      "SC-COM-AMBET": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from SC audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from SC audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from SC audit doc"
        }
      },
      "SC-COM-BCBSSC": {
        "Aimovig": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics/CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from SC audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics/CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Prime Therapeutics/CVS Caremark national formulary; verify via payer portal"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics/CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Prime Therapeutics/CVS Caremark national formulary; verify via payer portal"
        },
        "Nurtec ODT": {
          "status": "",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics/CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ubrelvy": {
          "status": "",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics/CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": ""
        }
      },
      "SC-COM-CIGNA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from SC audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from SC audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from SC audit doc"
        },
        "Zavzpret": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Tier 2 (Preferred Brand) with PA"
        }
      },
      "SC-COM-SCARBCBS": {
        "Aimovig": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from SC audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Prime Therapeutics national formulary; verify via payer portal"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Prime Therapeutics national formulary; verify via payer portal"
        }
      },
      "SC-COM-UHC": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from SC audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "30/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from OptumRx national formulary; verify via payer portal"
        },
        "Zavzpret": {
          "status": "",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Tier 4"
        }
      },
      "SC-MA-AETNACARE": {
        "Aimovig": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from SC audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from SC audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from SC audit doc"
        }
      },
      "SC-MA-HUMANA": {
        "Aimovig": {
          "status": "Excluded",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Excluded (Nonformulary)"
        },
        "Ajovy": {
          "status": "Excluded",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Excluded (Nonformulary)"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from SC audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Excluded",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Excluded (Nonformulary)"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Excluded",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Excluded (Nonformulary)"
        }
      },
      "SC-MA-MOLINA": {
        "Aimovig": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from SC audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from SC audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from SC audit doc"
        }
      },
      "SC-MA-SCBCBS": {
        "Aimovig": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from SC audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from SC audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from SC audit doc"
        }
      },
      "SC-MA-UHC": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from SC audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from SC audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from SC audit doc"
        }
      },
      "SC-MAC-PALMETTO": {
        "Botox": {
          "status": "",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "N/A - Medical Benefit",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        }
      },
      "SC-MCD-ABSOLUTE": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from SC audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from SC audit doc"
        },
        "Zavzpret": {
          "status": "Not Covered",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Not Covered (PA Required)"
        }
      },
      "SC-MCD-HEALTHYBLUE": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from SC audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from SC audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from SC audit doc"
        },
        "Zavzpret": {
          "status": "Not Covered",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Not Covered (PA Required)"
        }
      },
      "SC-MCD-MOLINA": {
        "Aimovig": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from SC audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from SC audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from SC audit doc"
        },
        "Zavzpret": {
          "status": "Not Covered",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Not Covered (PA Required)"
        }
      },
      "SC-MCD-SCDHHS": {
        "Aimovig": {
          "status": "",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Magellan Rx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        },
        "Ajovy": {
          "status": "",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Magellan Rx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        },
        "Emgality": {
          "status": "",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Magellan Rx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        },
        "Nurtec ODT": {
          "status": "",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Magellan Rx",
          "confidence": "Gap-Manual-Review",
          "notes": "No audit data or PBM match; PBM=Magellan Rx; requires manual verification"
        },
        "Ubrelvy": {
          "status": "",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Magellan Rx",
          "confidence": "Gap-Manual-Review",
          "notes": "No audit data or PBM match; PBM=Magellan Rx; requires manual verification"
        },
        "Zavzpret": {
          "status": "Not Covered",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Not Covered (PA Required)"
        }
      },
      "SC-MCD-SELECTSC": {
        "Aimovig": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from SC audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from SC audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from SC audit doc"
        },
        "Zavzpret": {
          "status": "Not Covered",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Not Covered (PA Required)"
        }
      },
      "SC-PARTB-PALMETTO": {
        "Botox": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from SC audit doc"
        }
      },
      "SD-COM-AVERA": {
        "Aimovig": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "Step within class: Aimovig/Ajovy",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "Step within class: Ajovy/Emgality/Aimovig",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from SD audit doc"
        },
        "Emgality": {
          "status": "Non-Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "Step within class: Emgality/Aimovig",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "30/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from  national formulary; verify via payer portal | Remapped from SD-PARTD-VARIOUS"
        }
      },
      "SD-COM-MEDICA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "Step within class: Aimovig/Ajovy",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from SD audit doc"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "Step within class: Ajovy/Emgality/Aimovig",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from SD audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from SD audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "Step within class: Emgality/Aimovig",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from SD audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from SD audit doc"
        }
      },
      "SD-COM-SANFORD": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "Step within class: Aimovig/Ajovy",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ajovy": {
          "status": "",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "Step within class: Ajovy/Emgality/Aimovig",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from SD audit doc"
        },
        "Emgality": {
          "status": "",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "Step within class: Emgality/Aimovig",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": ""
        }
      },
      "SD-COM-WELLMARK": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "Step within class: Aimovig/Ajovy",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "Step within class: Ajovy/Emgality/Aimovig",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "Step within class: Emgality/Aimovig",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": ""
        }
      },
      "SD-MA-AVERA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "Step within class: Aimovig/Ajovy",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from SD audit doc"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "Step within class: Ajovy/Emgality/Aimovig",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from SD audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from SD audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "Step within class: Emgality/Aimovig",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from SD audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from SD audit doc"
        }
      },
      "SD-MA-MEDICA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "Step within class: Aimovig/Ajovy",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from SD audit doc"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "Step within class: Ajovy/Emgality/Aimovig",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from SD audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from SD audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "Step within class: Emgality/Aimovig",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from SD audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from SD audit doc"
        }
      },
      "SD-MA-SANFORD": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "Step within class: Aimovig/Ajovy",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from SD audit doc"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "Step within class: Ajovy/Emgality/Aimovig",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from SD audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from SD audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "Step within class: Emgality/Aimovig",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from SD audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from SD audit doc"
        }
      },
      "SD-MA-UHC": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "Step within class: Aimovig/Ajovy",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from SD audit doc"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "Step within class: Ajovy/Emgality/Aimovig",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from SD audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from SD audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "Step within class: Emgality/Aimovig",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from SD audit doc"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from SD audit doc"
        }
      },
      "SD-MAC-NORIDIAN": {
        "Botox": {
          "status": "",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "N/A - Medical Benefit",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        }
      },
      "SD-MCD-DSS": {
        "Aimovig": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "Step within class: Aimovig/Ajovy",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "Step within class: Ajovy/Emgality/Aimovig",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Emgality": {
          "status": "Non-Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "Step within class: Emgality/Aimovig",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from OptumRx national formulary; verify via payer portal"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": ""
        }
      },
      "SD-MCD-SDDSS": {
        "Aimovig": {
          "status": "",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "Step within class: Aimovig/Ajovy",
          "siteOfCare": "",
          "pbm": "State SPBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        },
        "Ajovy": {
          "status": "",
          "tier": "",
          "qty": "",
          "stepInClass": "Step within class: Ajovy/Emgality/Aimovig",
          "siteOfCare": "",
          "pbm": "State SPBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        },
        "Emgality": {
          "status": "",
          "tier": "",
          "qty": "",
          "stepInClass": "Step within class: Emgality/Aimovig",
          "siteOfCare": "",
          "pbm": "State SPBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        }
      },
      "SD-PARTB-NORIDIAN": {
        "Botox": {
          "status": "",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        }
      },
      "TN-CHIP-AMERIGROUP": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Elevance PBM",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Elevance PBM",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Elevance PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from TN audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Elevance PBM",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Elevance PBM",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Elevance PBM",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Elevance PBM",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Elevance PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from TN audit doc"
        }
      },
      "TN-CHIP-UHC": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from TN audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from TN audit doc"
        }
      },
      "TN-COM-AETNA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from TN audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from TN audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from TN audit doc"
        }
      },
      "TN-COM-AMBET": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from TN audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from TN audit doc"
        }
      },
      "TN-COM-BCBST": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "BCBST PBM",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ajovy": {
          "status": "",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "BCBST PBM",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "BCBST PBM",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Nurtec ODT": {
          "status": "",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "BCBST PBM",
          "confidence": "Gap-Manual-Review",
          "notes": "No audit data or PBM match; PBM=BCBST PBM; requires manual verification"
        },
        "Ubrelvy": {
          "status": "",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "BCBST PBM",
          "confidence": "Gap-Manual-Review",
          "notes": "No audit data or PBM match; PBM=BCBST PBM; requires manual verification"
        }
      },
      "TN-COM-CIGNA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from TN audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from TN audit doc"
        },
        "Zavzpret": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Tier 2 (Preferred Brand) with PA"
        }
      },
      "TN-COM-TENBCBS": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from TN audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Prime Therapeutics national formulary; verify via payer portal"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Prime Therapeutics national formulary; verify via payer portal"
        }
      },
      "TN-COM-UHC": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from OptumRx national formulary; verify via payer portal"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "30/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from OptumRx national formulary; verify via payer portal"
        }
      },
      "TN-MA-AETNACARE": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from TN audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from TN audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Non-preferred; requires documented inadequate response to BOTH preferred agents (Aimovig AND Qulipta) before Vyepti is c"
        }
      },
      "TN-MA-CIGNA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from TN audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from TN audit doc"
        }
      },
      "TN-MA-HUMANA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from TN audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from TN audit doc"
        }
      },
      "TN-MA-TNBCBS": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from TN audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from TN audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from TN audit doc"
        }
      },
      "TN-MA-UHC": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from TN audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from TN audit doc"
        }
      },
      "TN-MAC-PALMETTO": {
        "Botox": {
          "status": "",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "N/A - Medical Benefit",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        }
      },
      "TN-MCD-AMERIGROUP": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from TN audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from TN audit doc"
        }
      },
      "TN-MCD-BLUECARE": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark/OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from TN audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark/OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark/OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from TN audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark/OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark/OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark/OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark/OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark/OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from TN audit doc"
        }
      },
      "TN-MCD-TENNCARE": {
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "30/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Prime Therapeutics national formulary; verify via payer portal"
        }
      },
      "TN-MCD-TNBLUECARE": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from TN audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from TN audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from TN audit doc"
        }
      },
      "TN-MCD-UHC": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from TN audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from TN audit doc"
        }
      },
      "TN-MCD-WELLPOINT": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 1",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Carelon/OptumRx",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ajovy": {
          "status": "",
          "tier": "Tier 1",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Carelon/OptumRx",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 1",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Carelon/OptumRx",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Carelon/OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Carelon/OptumRx national formulary; verify via payer portal"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Carelon/OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Carelon/OptumRx national formulary; verify via payer portal"
        }
      },
      "TN-PARTB-PALMETTO": {
        "Botox": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from TN audit doc"
        }
      },
      "TX-COM-AMBET": {
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "30/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from  national formulary; verify via payer portal | Remapped from TX-ACA-AMBETTER"
        },
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Express Scripts national formulary; verify via payer portal"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Express Scripts national formulary; verify via payer portal"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Express Scripts national formulary; verify via payer portal"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Express Scripts national formulary; verify via payer portal"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Express Scripts national formulary; verify via payer portal"
        }
      },
      "TX-CHIP-AMERIGROUP": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Elevance PBM",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Elevance PBM",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Elevance PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from TX audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Elevance PBM",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Elevance PBM",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Elevance PBM",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Elevance PBM",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Elevance PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from TX audit doc"
        }
      },
      "TX-CHIP-BCBSTX": {
        "Aimovig": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from TX audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from TX audit doc"
        }
      },
      "TX-CHIP-MOLINA": {
        "Aimovig": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from TX audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from TX audit doc"
        }
      },
      "TX-CHIP-SUPERIOR": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Centene PBM",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Centene PBM",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Centene PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from TX audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Centene PBM",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Centene PBM",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Centene PBM",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Centene PBM",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Centene PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from TX audit doc"
        }
      },
      "TX-CHIP-UHC": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from TX audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from TX audit doc"
        }
      },
      "TX-COM-AETNA": {
        "Aimovig": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from TX audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from TX audit doc"
        }
      },
      "TX-COM-BCBSTX": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from TX audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Nurtec ODT": {
          "status": "",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Prime Therapeutics national formulary; verify via payer portal"
        }
      },
      "TX-COM-CIGNA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ajovy": {
          "status": "",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from TX audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Nurtec ODT": {
          "status": "",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ubrelvy": {
          "status": "",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Zavzpret": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Tier 2 (Preferred Brand)"
        }
      },
      "TX-COM-OSCAR": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from TX audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from TX audit doc"
        }
      },
      "TX-COM-UHC": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ajovy": {
          "status": "Excluded",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from TX audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Nurtec ODT": {
          "status": "",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ubrelvy": {
          "status": "",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from TX audit doc"
        }
      },
      "TX-MA-AETNACARE": {
        "Aimovig": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from TX audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from TX audit doc"
        }
      },
      "TX-MA-CIGNA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from TX audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from TX audit doc"
        }
      },
      "TX-MA-HUMANA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from TX audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from TX audit doc"
        }
      },
      "TX-MA-TXBCBS": {
        "Aimovig": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from TX audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from TX audit doc"
        }
      },
      "TX-MA-UHC": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from TX audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from TX audit doc"
        }
      },
      "TX-MAC-NOVITAS": {
        "Botox": {
          "status": "",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "N/A - Medical Benefit",
          "confidence": "Gap-Manual-Review",
          "notes": "No audit data or PBM match; PBM=N/A - Medical Benefit; requires manual verification"
        }
      },
      "TX-MCD-AETNABETTER": {
        "Aimovig": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from TX audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from TX audit doc"
        }
      },
      "TX-MCD-AMERIGROUP": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from TX audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from TX audit doc"
        }
      },
      "TX-MCD-COMMCHOICE": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from TX audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from TX audit doc"
        }
      },
      "TX-MCD-DELLCHILD": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from TX audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from TX audit doc"
        }
      },
      "TX-MCD-DRISCOLL": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from TX audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from TX audit doc"
        }
      },
      "TX-MCD-ELPASO": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from TX audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from TX audit doc"
        }
      },
      "TX-MCD-MOLINA": {
        "Aimovig": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from TX audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from TX audit doc"
        }
      },
      "TX-MCD-PARKLAND": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from TX audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from TX audit doc"
        }
      },
      "TX-MCD-SUPERIOR": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Envolve Pharmacy Solutions national formulary; verify via payer portal"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Envolve Pharmacy Solutions national formulary; verify via payer portal"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from TX audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Envolve Pharmacy Solutions national formulary; verify via payer portal"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "9/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Envolve Pharmacy Solutions national formulary; verify via payer portal"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "9/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Envolve Pharmacy Solutions national formulary; verify via payer portal"
        }
      },
      "TX-MCD-TXCHILD": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from TX audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from TX audit doc"
        }
      },
      "TX-MCD-TXMEDICAID": {
        "Emgality (Cluster)": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from  national formulary; verify via payer portal | Remapped from TX-MCD-TXMEDICAID-CLUSTER (cluster variant)"
        },
        "Zavzpret": {
          "status": "Covered",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Covered with PDL PA Required"
        }
      },
      "TX-MCD-UHC": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from OptumRx national formulary; verify via payer portal"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from OptumRx national formulary; verify via payer portal"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from OptumRx national formulary; verify via payer portal"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "9/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from OptumRx national formulary; verify via payer portal"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "9/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from OptumRx national formulary; verify via payer portal"
        }
      },
      "TX-PARTB-NOVITAS": {
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from  national formulary; verify via payer portal"
        }
      },
      "UT-CHIP-MOLINA": {
        "Aimovig": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "HOPD",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from UT audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from UT audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from UT audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Home Infusion",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from UT audit doc"
        }
      },
      "UT-COM-CIGNA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "HOPD",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from UT audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from UT audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from UT audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Home Infusion",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from UT audit doc"
        },
        "Zavzpret": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Preferred Brand, Tier 2"
        }
      },
      "UT-COM-INTERMT": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "HOPD",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from UT audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from UT audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from UT audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Home Infusion",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from UT audit doc"
        }
      },
      "UT-COM-MOLINA": {
        "Aimovig": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "HOPD",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from UT audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from UT audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from UT audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Home Infusion",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from UT audit doc"
        }
      },
      "UT-COM-REGENCE": {
        "Aimovig": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Prime Therapeutics national formulary; verify via payer portal"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Prime Therapeutics national formulary; verify via payer portal"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Prime Therapeutics national formulary; verify via payer portal"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Home/Freestanding Preferred",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Prime Therapeutics national formulary; verify via payer portal"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "30/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from  national formulary; verify via payer portal | Remapped from UT-COM-SELECT"
        }
      },
      "UT-COM-SELECTHEALTH": {
        "Aimovig": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Emgality": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Nurtec ODT": {
          "status": "",
          "tier": "Tier 4",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ubrelvy": {
          "status": "",
          "tier": "Tier 4",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": ""
        }
      },
      "UT-COM-UHC": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from OptumRx national formulary; verify via payer portal"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Zavzpret": {
          "status": "",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Tier 4; Medication will not be used in combination with another acute CGRP antagonist (e.g. Nurtec ODT)"
        }
      },
      "UT-COM-UUHP": {
        "Aimovig": {
          "status": "Non-Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "UUHP PBM",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "UUHP PBM",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Emgality": {
          "status": "Non-Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "UUHP PBM",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Emgality (Cluster)": {
          "status": "Restricted",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "UUHP PBM",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Qulipta": {
          "status": "",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "UUHP PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        }
      },
      "UT-MA-AETNACARE": {
        "Aimovig": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "HOPD",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from UT audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from UT audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from UT audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Home Infusion",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from UT audit doc"
        }
      },
      "UT-MA-HUMANA": {
        "Aimovig": {
          "status": "Not Covered",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Not Covered (Nonformulary)"
        },
        "Ajovy": {
          "status": "Not Covered",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Not Covered (Nonformulary)"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "HOPD",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from UT audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Not Covered",
          "tier": "Tier 4",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Not Covered (Nonformulary)"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from UT audit doc"
        },
        "Vyepti": {
          "status": "Not Covered",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Home Infusion",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Not Covered (Nonformulary)"
        }
      },
      "UT-MA-SELECTHEALTH": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "HOPD",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from UT audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from UT audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from UT audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Home Infusion",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from UT audit doc"
        }
      },
      "UT-MA-UHC": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "HOPD",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from UT audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from UT audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from UT audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Home Infusion",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from UT audit doc"
        }
      },
      "UT-MAC-NORIDIAN": {
        "Botox": {
          "status": "",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "HOPD",
          "pbm": "N/A - Medical Benefit",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        }
      },
      "UT-MCD-MOLINA": {
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "30/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from  national formulary; verify via payer portal | Remapped from UT-MCD-HEALTHYU"
        },
        "Aimovig": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from CVS Caremark national formulary; verify via payer portal"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from CVS Caremark national formulary; verify via payer portal"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from CVS Caremark national formulary; verify via payer portal"
        }
      },
      "UT-MCD-SELECT": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "HOPD",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from UT audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from UT audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from UT audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Home Infusion",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from UT audit doc"
        }
      },
      "UT-MCD-UNIVUTAH": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "HOPD",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from UT audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from UT audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from UT audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Home Infusion",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from UT audit doc"
        },
        "Zavzpret": {
          "status": "Excluded",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Excluded/Not covered"
        }
      },
      "UT-PARTB-NORIDIAN": {
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "HOPD",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from UT audit doc"
        }
      },
      "VA-CHIP-AETNA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VA audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "HOPD",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VA audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "Fail Aimovig first",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VA audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VA audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "10/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VA audit doc"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VA audit doc"
        }
      },
      "VA-CHIP-ANTHEM": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Elevance PBM",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Elevance PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VA audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "HOPD",
          "pbm": "Elevance PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VA audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "Fail Aimovig first",
          "siteOfCare": "",
          "pbm": "Elevance PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VA audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Elevance PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VA audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Elevance PBM",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "10/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Elevance PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VA audit doc"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Elevance PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VA audit doc"
        }
      },
      "VA-CHIP-MOLINA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VA audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "HOPD",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VA audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "Fail Aimovig first",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VA audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VA audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "10/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VA audit doc"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VA audit doc"
        }
      },
      "VA-CHIP-UHC": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VA audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "HOPD",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VA audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "Fail Aimovig first",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VA audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VA audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "10/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VA audit doc"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VA audit doc"
        }
      },
      "VA-COM-AETNA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VA audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "HOPD",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VA audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "Fail Aimovig first",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VA audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VA audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "10/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VA audit doc"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VA audit doc"
        }
      },
      "VA-COM-ANTHEM": {
        "Emgality (Cluster)": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "Fail Aimovig first",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VA audit doc | Remapped from VA-COM-ANTHEM-CLUSTER (cluster variant)"
        }
      },
      "VA-COM-CIGNA": {
        "Aimovig": {
          "status": "Non-Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "HOPD",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VA audit doc"
        },
        "Emgality": {
          "status": "Non-Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "Fail Aimovig first",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VA audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "Fail injectable CGRP first",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Express Scripts national formulary; verify via payer portal"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "10/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VA audit doc"
        },
        "Zavzpret": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Tier 2 (Preferred Brand)"
        }
      },
      "VA-COM-ELEV": {
        "Aimovig": {
          "status": "Non-Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "HOPD",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VA audit doc"
        },
        "Emgality": {
          "status": "Non-Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "Fail Aimovig first",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "",
          "qty": "10/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VA audit doc"
        }
      },
      "VA-COM-KAISER": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Kaiser Permanente (Internal)/MedImpact",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Kaiser Permanente (Internal)/MedImpact",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VA audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "HOPD",
          "pbm": "Kaiser Permanente (Internal)/MedImpact",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VA audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "Fail Aimovig first",
          "siteOfCare": "",
          "pbm": "Kaiser Permanente (Internal)/MedImpact",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VA audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Kaiser Permanente (Internal)/MedImpact",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VA audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Kaiser Permanente (Internal)/MedImpact",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "10/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Kaiser Permanente (Internal)/MedImpact",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VA audit doc"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Kaiser Permanente (Internal)/MedImpact",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VA audit doc"
        }
      },
      "VA-COM-OSCAR": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VA audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "HOPD",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VA audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "Fail Aimovig first",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VA audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VA audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "10/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VA audit doc"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VA audit doc"
        }
      },
      "VA-COM-SENTARA": {
        "Aimovig": {
          "status": "Non-Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Sentara PBM",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Sentara PBM",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Botox": {
          "status": "",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "HOPD",
          "pbm": "Sentara PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        },
        "Emgality": {
          "status": "Non-Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "Fail Aimovig first",
          "siteOfCare": "",
          "pbm": "Sentara PBM",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Sentara PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        },
        "Qulipta": {
          "status": "",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Sentara PBM",
          "confidence": "Gap-Manual-Review",
          "notes": "No audit data or PBM match; PBM=Sentara PBM; requires manual verification"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Sentara PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        }
      },
      "VA-COM-UHC": {
        "Aimovig": {
          "status": "Non-Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ajovy": {
          "status": "Excluded",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "HOPD",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VA audit doc"
        },
        "Emgality": {
          "status": "Non-Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "Fail Aimovig first",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Nurtec ODT": {
          "status": "Restricted",
          "tier": "",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "10/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VA audit doc"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VA audit doc"
        }
      },
      "VA-MA-AETNACARE": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VA audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "HOPD",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VA audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "Fail Aimovig first",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VA audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VA audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "10/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VA audit doc"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VA audit doc"
        }
      },
      "VA-MA-ELEV": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VA audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "HOPD",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VA audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "Fail Aimovig first",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VA audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VA audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "10/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VA audit doc"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VA audit doc"
        }
      },
      "VA-MA-HUMANA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VA audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "HOPD",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VA audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "Fail Aimovig first",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VA audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VA audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "10/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VA audit doc"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VA audit doc"
        }
      },
      "VA-MA-KAISER": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Kaiser Permanente (Internal)/MedImpact",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Kaiser Permanente (Internal)/MedImpact",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VA audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "HOPD",
          "pbm": "Kaiser Permanente (Internal)/MedImpact",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VA audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "Fail Aimovig first",
          "siteOfCare": "",
          "pbm": "Kaiser Permanente (Internal)/MedImpact",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VA audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Kaiser Permanente (Internal)/MedImpact",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VA audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Kaiser Permanente (Internal)/MedImpact",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "10/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Kaiser Permanente (Internal)/MedImpact",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VA audit doc"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Kaiser Permanente (Internal)/MedImpact",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VA audit doc"
        }
      },
      "VA-MA-UHC": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VA audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "HOPD",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VA audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "Fail Aimovig first",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VA audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VA audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "10/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VA audit doc"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VA audit doc"
        }
      },
      "VA-MAC-PALMETTO": {
        "Botox": {
          "status": "",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "HOPD",
          "pbm": "N/A - Medical Benefit",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        }
      },
      "VA-MCD-AETNABETTER": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VA audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "HOPD",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VA audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "Fail Aimovig first",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VA audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VA audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "10/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VA audit doc"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VA audit doc"
        }
      },
      "VA-MCD-ANTHEM": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VA audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "HOPD",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VA audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "Fail Aimovig first",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VA audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VA audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "10/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VA audit doc"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VA audit doc"
        }
      },
      "VA-MCD-CARDINAL": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "State-managed",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "State-managed",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Botox": {
          "status": "",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "HOPD",
          "pbm": "State-managed",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "Fail Aimovig first",
          "siteOfCare": "",
          "pbm": "State-managed",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "State-managed",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "",
          "qty": "10/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "State-managed",
          "confidence": "Audit-Derived",
          "notes": ""
        }
      },
      "VA-MCD-HUMANA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VA audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "HOPD",
          "pbm": "Humana Pharmacy",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VA audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "Fail Aimovig first",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VA audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VA audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "10/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VA audit doc"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Humana Pharmacy",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VA audit doc"
        }
      },
      "VA-MCD-MAGELLAN": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VA audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "HOPD",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VA audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "Fail Aimovig first",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VA audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VA audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "10/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VA audit doc"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VA audit doc"
        }
      },
      "VA-MCD-MOLINA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VA audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "HOPD",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VA audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "Fail Aimovig first",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VA audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VA audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "10/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VA audit doc"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VA audit doc"
        }
      },
      "VA-MCD-OPTIMA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VA audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "HOPD",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VA audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "Fail Aimovig first",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VA audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VA audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "10/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VA audit doc"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VA audit doc"
        }
      },
      "VA-MCD-UHC": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VA audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "HOPD",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VA audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "Fail Aimovig first",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VA audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VA audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "10/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VA audit doc"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VA audit doc"
        }
      },
      "VA-MCD-VIRGINIAP": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VA audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "HOPD",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VA audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "Fail Aimovig first",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VA audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VA audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "10/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VA audit doc"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VA audit doc"
        }
      },
      "VA-PARTB-PALMETTO": {
        "Botox": {
          "status": "",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "HOPD",
          "pbm": "N/A - Medicare",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "N/A - Medicare",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        }
      },
      "VT-COM-BCBSVT": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "BCBSVT PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        },
        "Ajovy": {
          "status": "Excluded",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "BCBSVT PBM",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Ajovy (fremanezumab) EXCLUDED from formulary (not covered) effective January 1, 2026. Formulary exception process availa"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "BCBSVT PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        },
        "Nurtec ODT": {
          "status": "",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "BCBSVT PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        },
        "Qulipta": {
          "status": "",
          "tier": "",
          "qty": "30/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "BCBSVT PBM",
          "confidence": "Gap-Manual-Review",
          "notes": "No audit data or PBM match; PBM=BCBSVT PBM; requires manual verification"
        },
        "Ubrelvy": {
          "status": "",
          "tier": "Tier 3",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "BCBSVT PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        }
      },
      "VT-COM-CIGNA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VT audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VT audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VT audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VT audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VT audit doc"
        }
      },
      "VT-COM-MVP": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "MVP PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "MVP PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "MVP PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        }
      },
      "VT-COM-MVPHEALTH": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Express Scripts national formulary; verify via payer portal"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VT audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VT audit doc"
        }
      },
      "VT-COM-UHC": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VT audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VT audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VT audit doc"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VT audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VT audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VT audit doc"
        },
        "Zavzpret": {
          "status": "Covered",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Formulary inclusion confirmed; covered strictly for acute treatment of migraine with mandatory Prior Authorization and S"
        }
      },
      "VT-COM-VERBCBS": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VT audit doc"
        },
        "Ajovy": {
          "status": "Excluded",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Ajovy EXCLUDED from formulary effective January 1, 2026. Formulary exception via PA available."
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VT audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VT audit doc"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VT audit doc"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VT audit doc"
        }
      },
      "VT-MA-AETNACARE": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VT audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VT audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VT audit doc"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VT audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VT audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VT audit doc"
        }
      },
      "VT-MA-HUMANA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        }
      },
      "VT-MA-MVPHEALTH": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VT audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VT audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VT audit doc"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VT audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VT audit doc"
        }
      },
      "VT-MA-UHC": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VT audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VT audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VT audit doc"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VT audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VT audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VT audit doc"
        }
      },
      "VT-MA-VTBCBS": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VT audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VT audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VT audit doc"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VT audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VT audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from VT audit doc"
        }
      },
      "VT-MAC-NGS": {
        "Botox": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "N/A - Medical Benefit",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        }
      },
      "VT-MCD-DVHA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "VT Medicaid PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "VT Medicaid PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "VT Medicaid PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        }
      },
      "VT-MCD-VTDVHA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "State SPBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "State SPBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "State SPBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        }
      },
      "VT-PARTB-NGS": {
        "Botox": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        }
      },
      "WA-CHIP-COORDCARE": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Centene PBM",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Centene PBM",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Centene PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WA audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Centene PBM",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 1",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Centene PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WA audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Centene PBM",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 1",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Centene PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WA audit doc"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Infusion Center",
          "pbm": "Centene PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WA audit doc"
        }
      },
      "WA-CHIP-MOLINA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WA audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WA audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 1",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WA audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 1",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WA audit doc"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Infusion Center",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WA audit doc"
        }
      },
      "WA-CHIP-UHC": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WA audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WA audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 1",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WA audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 1",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WA audit doc"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Infusion Center",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WA audit doc"
        }
      },
      "WA-COM-AETNA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WA audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WA audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 1",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WA audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 1",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WA audit doc"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Infusion Center",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WA audit doc"
        }
      },
      "WA-COM-KAISER": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Kaiser Permanente (Internal)/MedImpact",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Kaiser Permanente (Internal)/MedImpact",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Kaiser Permanente (Internal)/MedImpact",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WA audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Kaiser Permanente (Internal)/MedImpact",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Nurtec ODT": {
          "status": "",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Kaiser Permanente (Internal)/MedImpact",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ubrelvy": {
          "status": "",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Kaiser Permanente (Internal)/MedImpact",
          "confidence": "Audit-Derived",
          "notes": ""
        }
      },
      "WA-COM-MOLINA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WA audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WA audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 1",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WA audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 1",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WA audit doc"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Infusion Center",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WA audit doc"
        }
      },
      "WA-COM-PREMBC": {
        "Aimovig": {
          "status": "Non-Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WA audit doc"
        },
        "Emgality": {
          "status": "Non-Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Nurtec ODT": {
          "status": "",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "30/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from  national formulary; verify via payer portal | Remapped from WA-COM-PREMERA"
        },
        "Emgality (Cluster)": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from  national formulary; verify via payer portal | Remapped from WA-COM-PREMERA-CLUSTER (cluster variant) | Remapped from WA-COM-PREMERA"
        }
      },
      "WA-COM-REGENCE": {
        "Aimovig": {
          "status": "Non-Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WA audit doc"
        },
        "Emgality": {
          "status": "Non-Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Nurtec ODT": {
          "status": "Restricted",
          "tier": "Tier 1",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ubrelvy": {
          "status": "Restricted",
          "tier": "Tier 1",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WA audit doc"
        }
      },
      "WA-COM-UHC": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WA audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": ""
        }
      },
      "WA-MA-AETNACARE": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WA audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WA audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 1",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WA audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 1",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WA audit doc"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Infusion Center",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WA audit doc"
        }
      },
      "WA-MA-HUMANA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WA audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WA audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 1",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WA audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 1",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WA audit doc"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Infusion Center",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WA audit doc"
        }
      },
      "WA-MA-KAISER": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Kaiser Permanente (Internal)/MedImpact",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Kaiser Permanente (Internal)/MedImpact",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WA audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Kaiser Permanente (Internal)/MedImpact",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WA audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Kaiser Permanente (Internal)/MedImpact",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 1",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Kaiser Permanente (Internal)/MedImpact",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WA audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Kaiser Permanente (Internal)/MedImpact",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 1",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Kaiser Permanente (Internal)/MedImpact",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WA audit doc"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Infusion Center",
          "pbm": "Kaiser Permanente (Internal)/MedImpact",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WA audit doc"
        }
      },
      "WA-MA-PREMERA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WA audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WA audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 1",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WA audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 1",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WA audit doc"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Infusion Center",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WA audit doc"
        }
      },
      "WA-MA-REGENCEBS": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WA audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WA audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 1",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WA audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 1",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WA audit doc"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Infusion Center",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WA audit doc"
        }
      },
      "WA-MA-UHC": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WA audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WA audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 1",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WA audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 1",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WA audit doc"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Infusion Center",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WA audit doc"
        }
      },
      "WA-MAC-NORIDIAN": {
        "Botox": {
          "status": "",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "N/A - Medical Benefit",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        }
      },
      "WA-MCD-AMERIGROUP": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WA audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WA audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 1",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WA audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 1",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WA audit doc"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Infusion Center",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WA audit doc"
        }
      },
      "WA-MCD-APPLE": {
        "Aimovig": {
          "status": "Non-Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "State-managed",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "State-managed",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Botox": {
          "status": "Restricted",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "State-managed",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Emgality": {
          "status": "Non-Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "State-managed",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 1",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "State-managed",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 1",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "State-managed",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Aimovig | Nurtec ODT | Qulipta | Ubrelvy | Zavzpret": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: 2026 Apple Health PDL effective January 1, 2026. Aimovig: Preferred (P) with PA. Nurtec ODT: Non-Preferred (NP) with PA."
        }
      },
      "WA-MCD-COMMUNWA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WA audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WA audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 1",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WA audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 1",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WA audit doc"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Infusion Center",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WA audit doc"
        }
      },
      "WA-MCD-COORDCARE": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WA audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 1",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WA audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 1",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WA audit doc"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Infusion Center",
          "pbm": "Envolve Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WA audit doc"
        }
      },
      "WA-MCD-MOLINA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WA audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from CVS Caremark national formulary; verify via payer portal"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from CVS Caremark national formulary; verify via payer portal"
        }
      },
      "WA-MCD-UHC": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WA audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WA audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 1",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WA audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 1",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WA audit doc"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Infusion Center",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WA audit doc"
        }
      },
      "WA-PARTB-NORIDIAN": {
        "Vyepti": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "N/A - Medicare",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        }
      },
      "WI-CHIP-ANTHEM": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Elevance PBM",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Elevance PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WI audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Elevance PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WI audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Elevance PBM",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Elevance PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WI audit doc"
        },
        "Qulipta": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Elevance PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WI audit doc"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Elevance PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WI audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Elevance PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WI audit doc"
        }
      },
      "WI-COM-ANTHEM": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Carelon",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Carelon national formulary; verify via payer portal"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Carelon",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WI audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Carelon",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Carelon",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Carelon",
          "confidence": "Audit-Derived",
          "notes": ""
        }
      },
      "WI-COM-CGHC": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "Fail preferred CGRP first",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "Fail preferred CGRP first",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "Fail preferred CGRP first",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": ""
        }
      },
      "WI-COM-DEAN": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from CVS Caremark national formulary; verify via payer portal"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WI audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": ""
        }
      },
      "WI-COM-ELEV": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from IngenioRx (Carelon) national formulary; verify via payer portal"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WI audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from IngenioRx (Carelon) national formulary; verify via payer portal"
        }
      },
      "WI-COM-GROUPCOOP": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WI audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WI audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WI audit doc"
        },
        "Qulipta": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WI audit doc"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WI audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WI audit doc"
        }
      },
      "WI-COM-QUARTZ": {
        "Qulipta": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "30/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WI audit doc"
        }
      },
      "WI-COM-UHC": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WI audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": ""
        }
      },
      "WI-MA-AETNACARE": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WI audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WI audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WI audit doc"
        },
        "Qulipta": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WI audit doc"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WI audit doc"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Non-preferred; requires documented inadequate response to BOTH preferred agents (Aimovig AND Qulipta). Dual-failure step"
        }
      },
      "WI-MA-DEAN": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WI audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WI audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WI audit doc"
        },
        "Qulipta": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WI audit doc"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WI audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WI audit doc"
        },
        "Zavzpret": {
          "status": "",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Tier 3, PA required, QL 6 per 30 days"
        }
      },
      "WI-MA-ELEV": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WI audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WI audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WI audit doc"
        },
        "Qulipta": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WI audit doc"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WI audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WI audit doc"
        }
      },
      "WI-MA-HUMANA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WI audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WI audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WI audit doc"
        },
        "Qulipta": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WI audit doc"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WI audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WI audit doc"
        }
      },
      "WI-MA-UHC": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WI audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WI audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WI audit doc"
        },
        "Qulipta": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WI audit doc"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WI audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WI audit doc"
        }
      },
      "WI-MCD-ANTHEM": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WI audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WI audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WI audit doc"
        },
        "Qulipta": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WI audit doc"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WI audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WI audit doc"
        }
      },
      "WI-MCD-CHILDCOMM": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WI audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WI audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WI audit doc"
        },
        "Qulipta": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WI audit doc"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WI audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WI audit doc"
        }
      },
      "WI-MCD-COMPCARE": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WI audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WI audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WI audit doc"
        },
        "Qulipta": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WI audit doc"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WI audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WI audit doc"
        }
      },
      "WI-MCD-DEANHEALTH": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WI audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WI audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WI audit doc"
        },
        "Qulipta": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WI audit doc"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WI audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WI audit doc"
        }
      },
      "WI-MCD-FORWARD": {
        "Emgality (Cluster)": {
          "status": "Restricted",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "| Remapped from WI-MCD-FORWARD-CLUSTER (cluster variant)"
        }
      },
      "WI-MCD-FWH": {
        "Aimovig": {
          "status": "Non-Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "Fail preferred CGRP first",
          "siteOfCare": "",
          "pbm": "ForwardHealth PBM",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "Fail preferred CGRP first",
          "siteOfCare": "",
          "pbm": "ForwardHealth PBM",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Botox": {
          "status": "",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "ForwardHealth PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        },
        "Emgality": {
          "status": "Non-Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "Fail preferred CGRP first",
          "siteOfCare": "",
          "pbm": "ForwardHealth PBM",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "ForwardHealth PBM",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "ForwardHealth PBM",
          "confidence": "Audit-Derived",
          "notes": ""
        }
      },
      "WI-MCD-GHCSCW": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WI audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WI audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WI audit doc"
        },
        "Qulipta": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WI audit doc"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WI audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WI audit doc"
        }
      },
      "WI-MCD-MOLINA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WI audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WI audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WI audit doc"
        },
        "Qulipta": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WI audit doc"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WI audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WI audit doc"
        }
      },
      "WI-MCD-QUARTZ": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WI audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WI audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WI audit doc"
        },
        "Qulipta": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WI audit doc"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WI audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WI audit doc"
        }
      },
      "WI-MCD-UHC": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WI audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WI audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WI audit doc"
        },
        "Qulipta": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WI audit doc"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WI audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WI audit doc"
        }
      },
      "WI-MCD-WISCARE": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WI audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WI audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 2",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WI audit doc"
        },
        "Qulipta": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WI audit doc"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WI audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WI audit doc"
        }
      },
      "WI-PARTB-NGS": {
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WI audit doc"
        }
      },
      "WV-COM-HIGHBCBS": {
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "30/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from  national formulary; verify via payer portal | Remapped from WV-ACA-CARESOURCE"
        },
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Express Scripts national formulary; verify via payer portal"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Express Scripts national formulary; verify via payer portal"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WV audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Express Scripts national formulary; verify via payer portal"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WV audit doc"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WV audit doc"
        }
      },
      "WV-CHIP-AETNA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WV audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WV audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WV audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WV audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: IV infusion (eptinezumab)"
        }
      },
      "WV-CHIP-UNICARE": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Elevance PBM",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Elevance PBM",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Elevance PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WV audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Elevance PBM",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Elevance PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WV audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Elevance PBM",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Elevance PBM",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Preferred"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Elevance PBM",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: IV infusion (eptinezumab)"
        }
      },
      "WV-COM-AETNA": {
        "Aimovig": {
          "status": "Excluded",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Excluded"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Excluded",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Excluded"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WV audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WV audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: IV infusion (eptinezumab)"
        }
      },
      "WV-COM-CARESOURCE": {
        "Nurtec ODT": {
          "status": "",
          "tier": "Tier 4",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CareSource PBM",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ubrelvy": {
          "status": "",
          "tier": "Tier 4",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CareSource PBM",
          "confidence": "Audit-Derived",
          "notes": ""
        }
      },
      "WV-COM-CIGNA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WV audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WV audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WV audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: IV infusion (eptinezumab)"
        },
        "Zavzpret": {
          "status": "Excluded",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Excluded (Requires Medical Exception)"
        }
      },
      "WV-COM-HEALTHPLAN": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ajovy": {
          "status": "",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WV audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": ""
        }
      },
      "WV-COM-HIGHMARK": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Highmark PBM",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Highmark PBM",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Botox": {
          "status": "Restricted",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Highmark PBM",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Highmark PBM",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Nurtec ODT": {
          "status": "",
          "tier": "Tier 4",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Highmark PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        },
        "Ubrelvy": {
          "status": "Restricted",
          "tier": "",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Highmark PBM",
          "confidence": "Audit-Derived",
          "notes": ""
        }
      },
      "WV-COM-THP": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Nurtec ODT": {
          "status": "",
          "tier": "Tier 3",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ubrelvy": {
          "status": "",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Zavzpret": {
          "status": "Excluded",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Excluded (Requires Medical Exception)"
        }
      },
      "WV-COM-UHC": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WV audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WV audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WV audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: IV infusion (eptinezumab)"
        },
        "Zavzpret": {
          "status": "",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Tier 4 (PA, ST, QL)"
        }
      },
      "WV-ACA-CARESOURCE": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from  national formulary; verify via payer portal"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from  national formulary; verify via payer portal"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from  national formulary; verify via payer portal"
        }
      },
      "WV-MA-AETNACARE": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WV audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WV audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WV audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WV audit doc"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Non-preferred; requires documented inadequate response to BOTH preferred agents (Aimovig AND Qulipta). Dual-failure step"
        }
      },
      "WV-MA-HIGHMARK": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WV audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WV audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WV audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: IV infusion (eptinezumab)"
        }
      },
      "WV-MA-HUMANA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WV audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WV audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WV audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: IV infusion (eptinezumab)"
        }
      },
      "WV-MA-UHC": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WV audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WV audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WV audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: IV infusion (eptinezumab)"
        }
      },
      "WV-MAC-PALMETTO": {
        "Botox": {
          "status": "",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "N/A - Medical Benefit",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        }
      },
      "WV-MCD-AETNABETTER": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WV audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WV audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WV audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WV audit doc"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: IV infusion (eptinezumab)"
        },
        "Zavzpret": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Non-Preferred (Requires PA, 2 triptan failures + 1 acute CGRP failure)"
        }
      },
      "WV-MCD-BMS": {
        "Aimovig": {
          "status": "Non-Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "WV BMS PBM",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "WV BMS PBM",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Botox": {
          "status": "",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "WV BMS PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "WV BMS PBM",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Non-Preferred (Requires Medical Director review, available only on appeal)"
        },
        "Nurtec ODT": {
          "status": "",
          "tier": "Tier 4",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "WV BMS PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "WV BMS PBM",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Preferred"
        },
        "Zavzpret": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Non-Preferred (Requires PA, 2 triptan failures + 1 acute CGRP failure)"
        }
      },
      "WV-MCD-THEHEALTH": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WV audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WV audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Preferred"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: IV infusion (eptinezumab)"
        },
        "Zavzpret": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Non-Preferred (Requires PA, 2 triptan failures + 1 acute CGRP failure)"
        }
      },
      "WV-MCD-UNICARE": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WV audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WV audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "16/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Preferred"
        },
        "Vyepti": {
          "status": "Non-Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "IngenioRx (Carelon)",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only; SOC default: IV infusion (eptinezumab)"
        },
        "Zavzpret": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Non-Preferred (Requires PA, 2 triptan failures + 1 acute CGRP failure)"
        }
      },
      "WV-PARTB-PALMETTO": {
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "IV Infusion (any setting)",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WV audit doc"
        }
      },
      "WY-COM-AETNA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WY audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WY audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WY audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "CVS Caremark",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "CVS Caremark",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WY audit doc"
        }
      },
      "WY-COM-BCBSWY": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "BCBSWY PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "BCBSWY PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "BCBSWY PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        },
        "Nurtec ODT": {
          "status": "",
          "tier": "",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "BCBSWY PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        },
        "Ubrelvy": {
          "status": "",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "BCBSWY PBM",
          "confidence": "Gap-Manual-Review",
          "notes": "No audit data or PBM match; PBM=BCBSWY PBM; requires manual verification"
        }
      },
      "WY-COM-CIGNA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WY audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WY audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WY audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Express Scripts",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Express Scripts",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WY audit doc"
        }
      },
      "WY-COM-UHC": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WY audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WY audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WY audit doc"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from OptumRx national formulary; verify via payer portal"
        }
      },
      "WY-COM-WYBCBS": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Prime Therapeutics national formulary; verify via payer portal"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WY audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WY audit doc"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Inferred from Prime Therapeutics national formulary; verify via payer portal"
        },
        "Qulipta": {
          "status": "",
          "tier": "Tier 3",
          "qty": "30/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "| Remapped from WY-PARTD-VARIOUS"
        }
      },
      "WY-MA-HUMANA": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WY audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WY audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WY audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Humana Pharmacy Solutions",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WY audit doc"
        }
      },
      "WY-MA-UHC": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WY audit doc"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WY audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WY audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "OptumRx",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "OptumRx",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WY audit doc"
        }
      },
      "WY-MA-WYBCBS": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WY audit doc"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Botox": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WY audit doc"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "Tier 3",
          "qty": "8/30 days",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WY audit doc"
        },
        "Qulipta": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Ubrelvy": {
          "status": "Non-Preferred",
          "tier": "Tier 4",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "Prime Therapeutics",
          "confidence": "PBM-Inferred",
          "notes": "Payer in Registry but no policy record; PBM-inferred only"
        },
        "Vyepti": {
          "status": "Preferred",
          "tier": "Specialty",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "Prime Therapeutics",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment from WY audit doc"
        }
      },
      "WY-MAC-NORIDIAN": {
        "Botox": {
          "status": "",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "N/A - Medical Benefit",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        }
      },
      "WY-MCD-DHF": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "WY Medicaid PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "WY Medicaid PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        },
        "Botox": {
          "status": "",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "WY Medicaid PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "WY Medicaid PBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        }
      },
      "WY-MCD-WYMEDICAID": {
        "Aimovig": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "State SPBM",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ajovy": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "State SPBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        },
        "Botox": {
          "status": "",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "State SPBM",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        },
        "Emgality": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "State SPBM",
          "confidence": "Audit-Derived",
          "notes": ""
        },
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Preferred Step 2 agent; requires trial and failure of two triptan agents"
        }
      },
      "WY-PARTB-NORIDIAN": {
        "Botox": {
          "status": "",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "Physician Office",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Phase 2 enrichment filled gap"
        }
      },
      "AR-MCD-ARMEDIC": {
        "Zavzpret": {
          "status": "",
          "tier": "Tier 2",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Tier 2 (PA, QL)"
        }
      },
      "IN-CHIP-CARESOURCE": {
        "Zavzpret": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: status=Non-Preferred (PA required via SUPDL alignment), quantityLimit=6 devices/22 days"
        }
      },
      "KY-MCD-KYMED": {
        "Zavzpret": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Non-Preferred"
        }
      },
      "MA-MCD-MASSHLTH": {
        "Zavzpret": {
          "status": "Covered",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Covered with Prior Authorization"
        }
      },
      "MI-MCD-BCC": {
        "Zavzpret": {
          "status": "Covered",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Covered with PA (Quantity Limit: 8 devices per 30 days)"
        }
      },
      "MI-CHIP-BCBSM": {
        "Zavzpret": {
          "status": "Covered",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Covered with PA (Quantity Limit: 8 devices per 30 days)"
        }
      },
      "MN-CHIP-MNCARE": {
        "Zavzpret": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Non-preferred, PA Required, ST Required"
        }
      },
      "MN-CHIP-HEALTHPARTNERS": {
        "Zavzpret": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Non-preferred, PA Required, ST Required"
        }
      },
      "MN-CHIP-UCARE": {
        "Zavzpret": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Non-preferred, PA Required, ST Required"
        }
      },
      "MT-MCD-MTMED": {
        "Qulipta": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Preferred Agent"
        },
        "Zavzpret": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Non-Preferred"
        }
      },
      "MT-CHIP-HMKPLUS": {
        "Qulipta": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Preferred Agent"
        },
        "Zavzpret": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Non-Preferred"
        }
      },
      "ND-MCD-NDMEDIC": {
        "Zavzpret": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Non-Preferred"
        }
      },
      "ND-CHIP-HEALTHYSTEPS": {
        "Zavzpret": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Non-Preferred"
        }
      },
      "OH-COM-ANTHEM": {
        "Zavzpret": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Non-preferred (PA required, bypasses preferred acute gepants)"
        }
      },
      "OH-MCD-UPDL": {
        "Zavzpret": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Non-Preferred"
        }
      },
      "OK-CHIP-SOONERCARE": {
        "Nurtec ODT": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Preferred Agent"
        }
      },
      "PA-CHIP-HIGHMARK": {
        "Zavzpret": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Preferred"
        }
      },
      "SC-MCD-FIRSTCHOICE": {
        "Zavzpret": {
          "status": "Not Covered",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Not Covered (PA Required)"
        }
      },
      "UT-MCD-HEALTHYU": {
        "Zavzpret": {
          "status": "Excluded",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Excluded/Not covered"
        }
      },
      "WV-CHIP-WVCHIP": {
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Preferred"
        }
      },
      "WY-CHIP-KIDCARE": {
        "Ubrelvy": {
          "status": "Preferred",
          "tier": "",
          "qty": "",
          "stepInClass": "",
          "siteOfCare": "",
          "pbm": "",
          "confidence": "Audit-Derived",
          "notes": "Q1 2026 refresh: Preferred Step 2 agent; requires trial and failure of two triptan agents"
        }
      }
    }
  }
}