{"aaData": [["1", "
AMOUNT APPLIED TO PERIODIC DEDUCTIBLE
\n"], ["11", "
AMOUNT ATTRIBUTED TO PRODUCT SELECTION/BRAND NON-PREFERRED FORMULARY SELECTION
\n"], ["12", "
AMOUNT ATTRIBUTED TO COVERAGE GAP
\n"], ["13", "
AMOUNT ATTRIBUTED TO PROCESSOR FEE
\n"], ["14", "
AMOUNT ATTRIBUTED TO GRACE PERIOD
\n"], ["15", "
AMOUNT ATTRIBUTED TO CATASTROPHIC BENEFIT
\n"], ["16", "
AMOUNT ATTRIBUTED TO UNBALANCED PATIENT PAY OPPRA
\n"], ["17", "
AMOUNT ATTRIBUTED TO REGULATORY FEE
\n"], ["18", "
AMOUNT ATTRIBUTED TO SPEND DOWN
\n"], ["19", "
PT RESPONSIBILITY AMT NOT ASSOCIATED WITH MEDICARE PRESCRIPTION PAYMENT PLAN
\n"], ["2", "
AMOUNT ATTRIBUTED TO PRODUCT SELECTION/BRAND DRUG
\n"], ["3", "
AMOUNT ATTRIBUTED TO PERCENTAGE TAX
\n"], ["4", "
AMOUNT EXCEEDING PERIODIC BENEFIT MAXIMUM
\n"], ["5", "
AMOUNT OF COPAY
\n"], ["7", "
AMOUNT OF COINSURANCE
\n"], ["8", "
AMOUNT ATTRIBUTED TO PRODUCT SELECTION/NON-PREFERRED FORMULARY SELECTION
\n"], ["9", "
AMOUNT ATTRIBUTED TO HEALTH PLAN ASSISTANCE AMOUNT
\n"], ["10", "
AMOUNT ATTRIBUTED TO PROVIDER NETWORK SELECTION
\n"]]}