Product Overview

The two resources in this category can provide complete payer formulary information. Coverage information from the WhoAmI endpoint can retrieve details of a specific member’s plan formulary.

Product Description

As part of the CMS Interoperability and Patient Access final rule (CMS-9115-F), payers must make formulary information available. These APIs are required to retrieve the formulary information directly or on behalf of a member.

There are two formulary resources that conform to the HL7 FHIR standards. These resources provide information that together provide information on the formulary.

If information specific to a member is desired, then prior to calling this, you must have the proper authentication tokens. Also, the Who Am I API will be necessary to retrieve profile information on the logged in user and their dependents as well as the patient search criteria for the other APIs.

More details on this API can be found in the Capability Statement API as well as in the swagger document.

APIs in this category follow the DaVinci Payer Data Exchange US Drug Formulary Implementation Guide v1.0.1 found at https://build.fhir.org/ig/HL7/davinci-pdex-formulary/artifacts.html#3

Getting Started

Per the Regulation, the Formulary APIs are provided without authentication requirements. After validating your connectivity with the sandbox, please use the below details to connect to our Production APIs:

The URL for our Formulary Production endpoints adhere to the following format, where APINAME is replaced with the name of the API you are attempting to call:

https://apis.changehealthcare.com/anon/CMSPatientAccess/formulary/v2/APINAME

So for example, the Formulary Drug API can be called from:

https://apis.changehealthcare.com/anon/CMSPatientAccess/formulary/v2/MedicationKnowledge

Importantly, our Formulary APIs require the submission of "CHC Payer ID" parameter, where CHCPAYERID in the example below is replaced with the ID of the payer you are wishing to access (see Table below for full list of Sandbox and Production Payer IDs):

https://apis.changehealthcare.com/anon/CMSPatientAccess/formulary/v2/MedicationKnowledge?chc-payer-id=CHCPAYERID

Disclaimers

This product uses publicly available data courtesy of the U.S. National Library of Medicine (NLM), National Institutes of Health, Department of Health and Human Services; NLM is not responsible for the product and does not endorse or recommend this or any other product.

The publicly available data is the UMLS® Metathesaurus® for the 2020AB Release from 11/02/2020.

Some material in the UMLS Metathesaurus is from copyrighted sources of the respective copyright holders. Users of the UMLS Metathesaurus are solely responsible for compliance with any copyright, patent or trademark restrictions and are referred to the copyright, patent or trademark notices appearing in the original sources, all of which are hereby incorporated by reference.

Only portions of the UMLS Metathesaurus have been used in this product; the source vocabularies are as follows:

RXNORM_20AA_200908F (updated) - RxNorm; META2020AA Full Update 2020_09_08;Bethesda, MD; National Library of Medicine

This release contains concepts created by the National Library of Medicine which express the meaning of a drug name in a normalized form. These concepts relate the names of orderable medications to a dose form and the components of those medications. For further discussion, see the article at: https://www.nlm.nih.gov/research/umls/index.html

Contact: RxNorm Customer Service; U.S. National Library of Medicine; 8600 Rockville Pike; Bethesda, MD, United States 20894; (888) FIND-NLM; [email protected]; https://www.nlm.nih.gov/research/umls/rxnorm/

SNOMEDCT_US_2020_09_01 (updated) - SNOMED International; US Edition of SNOMED CT; London, United Kingdom; SNOMED International; September 1, 2020

This material includes SNOMED Clinical Terms® (SNOMED CT®) which is used by permission of the International Health Terminology Standards Development Organisation (IHTSDO). All rights reserved. SNOMED CT®, was originally created by The College of American Pathologists. "SNOMED" and "SNOMED CT" are registered trademarks of the IHTSDO.

Contact: UMLS Support, National Library of Medicine; e-mail: NLM SNOMED CT Support

NLM is a Charter Member of the IHTSDO on behalf of the U.S.

📘

Click here to learn about Sandbox Availability.

Payer IDs

To query the formulary of specific payer, please refer to the table below for the Payer ID parameter that can be used in the Formulary APIs.