Coverage

The Coverage resource allows the retrieval of Formulary Coverage information for any number of Products. The coverage information is grouped by the Controller and is accompanied by a winning status and percentage. The plans or controllers can also be filtered by a number of parameters.

Coverage for a specific Plan and Product

Alternative Coverage for a specific Plan and Product

Coverage for a specific Controller and Product

Coverage for a specific MCO and Product

Alternative Coverage for a specific Controller and Product

Alternative Coverage for a specific MCO and Product

Coverage by Product

Coverage for a specific Plan and Product


Request URL
GET Formulary/v1/Coverage/Plan


URI Parameters

NameDescription Type Required / Optional
ProductId

The Id of the Product

 integer

Required
PlanId

The Id of the Plan

 integer

Required
LivesTypeId

The Id to override the types of lives to shown (Default: 4)

 integer

Optional
ApplyNLPolicies

Turns Coverage ON/OFF for NL and NTM policies. When 'PoliciesOn', the policies are applied and when 'PoliciesOff', the policies are turned off.

 string

Optional
StatusMapping

Please contact support for various options available

 string

Optional

Resource Description of Response Object

PlanCoveragesResponse
NameDescription Type Required / Optional
PlanCoverages

Collection of PlanCoverage

Optional

Available Response Formats & Sample Data

{
  "PlanCoverages": [
    {
      "PlanId": 1,
      "PlanTypeId": 64,
      "ChannelId": 3,
      "ProductId": 4,
      "MonthId": 5,
      "ControllerId": 6,
      "NoteId": 1,
      "NotesAvailable": 7,
      "Lives": 8,
      "DrugListTierId": 64,
      "FormularyTierId": 10,
      "FormularyUnifiedTierId": 11,
      "UnifiedTierId": 12,
      "PromotionalTierId": 1,
      "IsGeneric": true,
      "PriorAuthorization": true,
      "StepTherapy": true,
      "QuantityLimit": true,
      "SpecialtyPharmacy": true,
      "ConditionalPriorAuthorization": true,
      "DurableMedicalEquipment": true,
      "MedicalBenefit": true,
      "OverTheCounter": true,
      "Variance": true,
      "StateCarveOut": true,
      "FormularyId": 24
    },
    {
      "PlanId": 1,
      "PlanTypeId": 64,
      "ChannelId": 3,
      "ProductId": 4,
      "MonthId": 5,
      "ControllerId": 6,
      "NoteId": 1,
      "NotesAvailable": 7,
      "Lives": 8,
      "DrugListTierId": 64,
      "FormularyTierId": 10,
      "FormularyUnifiedTierId": 11,
      "UnifiedTierId": 12,
      "PromotionalTierId": 1,
      "IsGeneric": true,
      "PriorAuthorization": true,
      "StepTherapy": true,
      "QuantityLimit": true,
      "SpecialtyPharmacy": true,
      "ConditionalPriorAuthorization": true,
      "DurableMedicalEquipment": true,
      "MedicalBenefit": true,
      "OverTheCounter": true,
      "Variance": true,
      "StateCarveOut": true,
      "FormularyId": 24
    }
  ]
}

<PlanCoveragesResponse xmlns:i="http://www.w3.org/2001/XMLSchema-instance" xmlns="http://api.mmitnetwork.com/formulary/coverages">
  <PlanCoverages>
    <PlanCoverage>
      <ChannelId>3</ChannelId>
      <ConditionalPriorAuthorization>true</ConditionalPriorAuthorization>
      <ControllerId>6</ControllerId>
      <DrugListTierId>64</DrugListTierId>
      <DurableMedicalEquipment>true</DurableMedicalEquipment>
      <FormularyId>24</FormularyId>
      <FormularyTierId>10</FormularyTierId>
      <FormularyUnifiedTierId>11</FormularyUnifiedTierId>
      <IsGeneric>true</IsGeneric>
      <Lives>8</Lives>
      <MedicalBenefit>true</MedicalBenefit>
      <MonthId>5</MonthId>
      <NoteId>1</NoteId>
      <NotesAvailable>7</NotesAvailable>
      <OverTheCounter>true</OverTheCounter>
      <PlanId>1</PlanId>
      <PlanTypeId>64</PlanTypeId>
      <PriorAuthorization>true</PriorAuthorization>
      <ProductId>4</ProductId>
      <PromotionalTierId>1</PromotionalTierId>
      <QuantityLimit>true</QuantityLimit>
      <SpecialtyPharmacy>true</SpecialtyPharmacy>
      <StateCarveOut>true</StateCarveOut>
      <StepTherapy>true</StepTherapy>
      <UnifiedTierId>12</UnifiedTierId>
      <Variance>true</Variance>
    </PlanCoverage>
    <PlanCoverage>
      <ChannelId>3</ChannelId>
      <ConditionalPriorAuthorization>true</ConditionalPriorAuthorization>
      <ControllerId>6</ControllerId>
      <DrugListTierId>64</DrugListTierId>
      <DurableMedicalEquipment>true</DurableMedicalEquipment>
      <FormularyId>24</FormularyId>
      <FormularyTierId>10</FormularyTierId>
      <FormularyUnifiedTierId>11</FormularyUnifiedTierId>
      <IsGeneric>true</IsGeneric>
      <Lives>8</Lives>
      <MedicalBenefit>true</MedicalBenefit>
      <MonthId>5</MonthId>
      <NoteId>1</NoteId>
      <NotesAvailable>7</NotesAvailable>
      <OverTheCounter>true</OverTheCounter>
      <PlanId>1</PlanId>
      <PlanTypeId>64</PlanTypeId>
      <PriorAuthorization>true</PriorAuthorization>
      <ProductId>4</ProductId>
      <PromotionalTierId>1</PromotionalTierId>
      <QuantityLimit>true</QuantityLimit>
      <SpecialtyPharmacy>true</SpecialtyPharmacy>
      <StateCarveOut>true</StateCarveOut>
      <StepTherapy>true</StepTherapy>
      <UnifiedTierId>12</UnifiedTierId>
      <Variance>true</Variance>
    </PlanCoverage>
  </PlanCoverages>
</PlanCoveragesResponse>

Build Request


NameDescription Input Value Type Required / Optional
ProductId

The Id of the Product

integer

Required
PlanId

The Id of the Plan

integer

Required
LivesTypeId

The Id to override the types of lives to shown (Default: 4)

integer

Optional
ApplyNLPolicies

Turns Coverage ON/OFF for NL and NTM policies. When 'PoliciesOn', the policies are applied and when 'PoliciesOff', the policies are turned off.

string

Optional
StatusMapping

Please contact support for various options available

string

Optional




Request URL

GET Formulary/v1/Coverage/Plan?ProductId=ProductId&PlanId=PlanId&LivesTypeId=LivesTypeId&ApplyNLPolicies=ApplyNLPolicies&StatusMapping=StatusMapping

Status

Response Details

Alternative Coverage for a specific Plan and Product


Request URL
GET Formulary/v1/Coverage/Plan/Alternatives


URI Parameters

NameDescription Type Required / Optional
ProductId

The Id of the Product to return alternatives for

 integer

Required
PlanId

The Id of the Plan

 integer

Required
DrugTypeId

The DrugTypeId of the Product to be returned

 byte

Optional
Options

Enter "CoveredOnly" to return only covered alternatives.

 Collection of string

Optional
LivesTypeId

The Id to override the types of lives to shown (Default: 4)

 integer

Optional
ApplyNLPolicies

Turns Coverage ON/OFF for NL and NTM policies. When 'PoliciesOn', the policies are applied and when 'PoliciesOff', the policies are turned off.

 string

Optional

Resource Description of Response Object

AlternativePlanCoveragesResponse
NameDescription Type Required / Optional
PlanCoverages

Collection of PlanCoverage

Optional
Products

Collection of Product

Optional

Available Response Formats & Sample Data

{
  "PlanCoverages": [
    {
      "PlanId": 1,
      "PlanTypeId": 64,
      "ChannelId": 3,
      "ProductId": 4,
      "MonthId": 5,
      "ControllerId": 6,
      "NoteId": 1,
      "NotesAvailable": 7,
      "Lives": 8,
      "DrugListTierId": 64,
      "FormularyTierId": 10,
      "FormularyUnifiedTierId": 11,
      "UnifiedTierId": 12,
      "PromotionalTierId": 1,
      "IsGeneric": true,
      "PriorAuthorization": true,
      "StepTherapy": true,
      "QuantityLimit": true,
      "SpecialtyPharmacy": true,
      "ConditionalPriorAuthorization": true,
      "DurableMedicalEquipment": true,
      "MedicalBenefit": true,
      "OverTheCounter": true,
      "Variance": true,
      "StateCarveOut": true,
      "FormularyId": 24
    },
    {
      "PlanId": 1,
      "PlanTypeId": 64,
      "ChannelId": 3,
      "ProductId": 4,
      "MonthId": 5,
      "ControllerId": 6,
      "NoteId": 1,
      "NotesAvailable": 7,
      "Lives": 8,
      "DrugListTierId": 64,
      "FormularyTierId": 10,
      "FormularyUnifiedTierId": 11,
      "UnifiedTierId": 12,
      "PromotionalTierId": 1,
      "IsGeneric": true,
      "PriorAuthorization": true,
      "StepTherapy": true,
      "QuantityLimit": true,
      "SpecialtyPharmacy": true,
      "ConditionalPriorAuthorization": true,
      "DurableMedicalEquipment": true,
      "MedicalBenefit": true,
      "OverTheCounter": true,
      "Variance": true,
      "StateCarveOut": true,
      "FormularyId": 24
    }
  ],
  "Products": [
    {
      "ProductId": 1,
      "TherapeuticClassId": 2,
      "TherapeuticClass": "sample string 3",
      "Drug": {
        "DrugId": 1,
        "DrugTypeId": 64,
        "Name": "sample string 3",
        "Description": "sample string 4",
        "Brand": "sample string 5",
        "IsGeneric": true,
        "OverTheCounter": true,
        "IsOwner": true,
        "Logo": "sample string 8",
        "ImportantSafetyInformation": "sample string 9",
        "Rank": 64
      },
      "DisplayName": "sample string 4"
    },
    {
      "ProductId": 1,
      "TherapeuticClassId": 2,
      "TherapeuticClass": "sample string 3",
      "Drug": {
        "DrugId": 1,
        "DrugTypeId": 64,
        "Name": "sample string 3",
        "Description": "sample string 4",
        "Brand": "sample string 5",
        "IsGeneric": true,
        "OverTheCounter": true,
        "IsOwner": true,
        "Logo": "sample string 8",
        "ImportantSafetyInformation": "sample string 9",
        "Rank": 64
      },
      "DisplayName": "sample string 4"
    }
  ]
}

<AlternativePlanCoveragesResponse xmlns:i="http://www.w3.org/2001/XMLSchema-instance" xmlns="http://api.mmitnetwork.com/formulary/coverages">
  <PlanCoverages>
    <PlanCoverage>
      <ChannelId>3</ChannelId>
      <ConditionalPriorAuthorization>true</ConditionalPriorAuthorization>
      <ControllerId>6</ControllerId>
      <DrugListTierId>64</DrugListTierId>
      <DurableMedicalEquipment>true</DurableMedicalEquipment>
      <FormularyId>24</FormularyId>
      <FormularyTierId>10</FormularyTierId>
      <FormularyUnifiedTierId>11</FormularyUnifiedTierId>
      <IsGeneric>true</IsGeneric>
      <Lives>8</Lives>
      <MedicalBenefit>true</MedicalBenefit>
      <MonthId>5</MonthId>
      <NoteId>1</NoteId>
      <NotesAvailable>7</NotesAvailable>
      <OverTheCounter>true</OverTheCounter>
      <PlanId>1</PlanId>
      <PlanTypeId>64</PlanTypeId>
      <PriorAuthorization>true</PriorAuthorization>
      <ProductId>4</ProductId>
      <PromotionalTierId>1</PromotionalTierId>
      <QuantityLimit>true</QuantityLimit>
      <SpecialtyPharmacy>true</SpecialtyPharmacy>
      <StateCarveOut>true</StateCarveOut>
      <StepTherapy>true</StepTherapy>
      <UnifiedTierId>12</UnifiedTierId>
      <Variance>true</Variance>
    </PlanCoverage>
    <PlanCoverage>
      <ChannelId>3</ChannelId>
      <ConditionalPriorAuthorization>true</ConditionalPriorAuthorization>
      <ControllerId>6</ControllerId>
      <DrugListTierId>64</DrugListTierId>
      <DurableMedicalEquipment>true</DurableMedicalEquipment>
      <FormularyId>24</FormularyId>
      <FormularyTierId>10</FormularyTierId>
      <FormularyUnifiedTierId>11</FormularyUnifiedTierId>
      <IsGeneric>true</IsGeneric>
      <Lives>8</Lives>
      <MedicalBenefit>true</MedicalBenefit>
      <MonthId>5</MonthId>
      <NoteId>1</NoteId>
      <NotesAvailable>7</NotesAvailable>
      <OverTheCounter>true</OverTheCounter>
      <PlanId>1</PlanId>
      <PlanTypeId>64</PlanTypeId>
      <PriorAuthorization>true</PriorAuthorization>
      <ProductId>4</ProductId>
      <PromotionalTierId>1</PromotionalTierId>
      <QuantityLimit>true</QuantityLimit>
      <SpecialtyPharmacy>true</SpecialtyPharmacy>
      <StateCarveOut>true</StateCarveOut>
      <StepTherapy>true</StepTherapy>
      <UnifiedTierId>12</UnifiedTierId>
      <Variance>true</Variance>
    </PlanCoverage>
  </PlanCoverages>
  <Products xmlns:d2p1="http://api.mmitnetwork.com/formulary/products">
    <d2p1:Product>
      <d2p1:DisplayName>sample string 4</d2p1:DisplayName>
      <d2p1:Drug>
        <d2p1:Brand>sample string 5</d2p1:Brand>
        <d2p1:Description>sample string 4</d2p1:Description>
        <d2p1:DrugId>1</d2p1:DrugId>
        <d2p1:DrugTypeId>64</d2p1:DrugTypeId>
        <d2p1:ImportantSafetyInformation>sample string 9</d2p1:ImportantSafetyInformation>
        <d2p1:IsGeneric>true</d2p1:IsGeneric>
        <d2p1:IsOwner>true</d2p1:IsOwner>
        <d2p1:Logo>sample string 8</d2p1:Logo>
        <d2p1:Name>sample string 3</d2p1:Name>
        <d2p1:OverTheCounter>true</d2p1:OverTheCounter>
        <d2p1:Rank>64</d2p1:Rank>
      </d2p1:Drug>
      <d2p1:ProductId>1</d2p1:ProductId>
      <d2p1:TherapeuticClass>sample string 3</d2p1:TherapeuticClass>
      <d2p1:TherapeuticClassId>2</d2p1:TherapeuticClassId>
    </d2p1:Product>
    <d2p1:Product>
      <d2p1:DisplayName>sample string 4</d2p1:DisplayName>
      <d2p1:Drug>
        <d2p1:Brand>sample string 5</d2p1:Brand>
        <d2p1:Description>sample string 4</d2p1:Description>
        <d2p1:DrugId>1</d2p1:DrugId>
        <d2p1:DrugTypeId>64</d2p1:DrugTypeId>
        <d2p1:ImportantSafetyInformation>sample string 9</d2p1:ImportantSafetyInformation>
        <d2p1:IsGeneric>true</d2p1:IsGeneric>
        <d2p1:IsOwner>true</d2p1:IsOwner>
        <d2p1:Logo>sample string 8</d2p1:Logo>
        <d2p1:Name>sample string 3</d2p1:Name>
        <d2p1:OverTheCounter>true</d2p1:OverTheCounter>
        <d2p1:Rank>64</d2p1:Rank>
      </d2p1:Drug>
      <d2p1:ProductId>1</d2p1:ProductId>
      <d2p1:TherapeuticClass>sample string 3</d2p1:TherapeuticClass>
      <d2p1:TherapeuticClassId>2</d2p1:TherapeuticClassId>
    </d2p1:Product>
  </Products>
</AlternativePlanCoveragesResponse>

Build Request


NameDescription Input Value Type Required / Optional
ProductId

The Id of the Product to return alternatives for

integer

Required
PlanId

The Id of the Plan

integer

Required
DrugTypeId

The DrugTypeId of the Product to be returned

byte

Optional
Options

Enter "CoveredOnly" to return only covered alternatives.

Collection of string

Optional
LivesTypeId

The Id to override the types of lives to shown (Default: 4)

integer

Optional
ApplyNLPolicies

Turns Coverage ON/OFF for NL and NTM policies. When 'PoliciesOn', the policies are applied and when 'PoliciesOff', the policies are turned off.

string

Optional




Request URL

GET Formulary/v1/Coverage/Plan/Alternatives?ProductId=ProductId&PlanId=PlanId&DrugTypeId=DrugTypeId&Options=Options&LivesTypeId=LivesTypeId&ApplyNLPolicies=ApplyNLPolicies

Status

Response Details

Coverage for a specific Controller and Product


Request URL
GET Formulary/v1/Coverage/Controller


URI Parameters

NameDescription Type Required / Optional
ProductId

The Id of the Product

 integer

Required
ControllerId

The Id of the Controller/Parent

 integer

Required
BenefitDesignId

The Id of the BenefitDesign used as a Plan filter the response

 integer

Optional
ChannelId

The Id of the Channel used as a Plan filter the response

 Collection of integer

Optional
PlanTypeId

The Id of the PlanType used as a Plan filter the response

 integer

Optional
StateId

The US State Id where the Plan(s) are covered

 string

Optional
CBSAId

The CBSA(Service Area) Id where the Plan is covered

 integer

Optional
TerritoryId

The Territory Id where the Plan is covered

 integer

Optional
Options

Enter "PlanCoverages" to include Plan level coverage in addition to Controller coverage. Enter "SummaryCoverages" to include a summary of all statuses in addition to Controller coverage.

 Collection of string

Optional
LivesTypeId

The Id to override the types of lives to shown (Default: 4)

 integer

Optional
ApplyNLPolicies

Turns Coverage ON/OFF for NL and NTM policies. When 'PoliciesOn', the policies are applied and when 'PoliciesOff', the policies are turned off.

 string

Optional

Resource Description of Response Object

ControllerCoveragesResponse
NameDescription Type Required / Optional
ControllerCoverages

Collection of Coverage

Optional
PlanCoverages

Collection of PlanCoverage

Optional
SummaryCoverages

Collection of UnifiedTierCoverage

Optional
Statement

string

Optional

Available Response Formats & Sample Data

{
  "ControllerCoverages": [
    {
      "ProductId": 1,
      "MonthId": 3,
      "ControllerId": 4,
      "DrugListTier": {
        "DrugListTierId": 64,
        "Percentage": 2,
        "Lives": 3,
        "PlanCount": 4
      },
      "UnifiedTier": {
        "UnifiedTierId": 1,
        "Percentage": 2,
        "Lives": 3,
        "PlanCount": 4
      },
      "PromotionalTier": {
        "PromotionalTierId": 1,
        "Percentage": 2,
        "Lives": 3,
        "PlanCount": 4
      },
      "Lives": 6,
      "PlanCount": 7
    },
    {
      "ProductId": 1,
      "MonthId": 3,
      "ControllerId": 4,
      "DrugListTier": {
        "DrugListTierId": 64,
        "Percentage": 2,
        "Lives": 3,
        "PlanCount": 4
      },
      "UnifiedTier": {
        "UnifiedTierId": 1,
        "Percentage": 2,
        "Lives": 3,
        "PlanCount": 4
      },
      "PromotionalTier": {
        "PromotionalTierId": 1,
        "Percentage": 2,
        "Lives": 3,
        "PlanCount": 4
      },
      "Lives": 6,
      "PlanCount": 7
    }
  ],
  "PlanCoverages": [
    {
      "PlanId": 1,
      "PlanTypeId": 64,
      "ChannelId": 3,
      "ProductId": 4,
      "MonthId": 5,
      "ControllerId": 6,
      "NoteId": 1,
      "NotesAvailable": 7,
      "Lives": 8,
      "DrugListTierId": 64,
      "FormularyTierId": 10,
      "FormularyUnifiedTierId": 11,
      "UnifiedTierId": 12,
      "PromotionalTierId": 1,
      "IsGeneric": true,
      "PriorAuthorization": true,
      "StepTherapy": true,
      "QuantityLimit": true,
      "SpecialtyPharmacy": true,
      "ConditionalPriorAuthorization": true,
      "DurableMedicalEquipment": true,
      "MedicalBenefit": true,
      "OverTheCounter": true,
      "Variance": true,
      "StateCarveOut": true,
      "FormularyId": 24
    },
    {
      "PlanId": 1,
      "PlanTypeId": 64,
      "ChannelId": 3,
      "ProductId": 4,
      "MonthId": 5,
      "ControllerId": 6,
      "NoteId": 1,
      "NotesAvailable": 7,
      "Lives": 8,
      "DrugListTierId": 64,
      "FormularyTierId": 10,
      "FormularyUnifiedTierId": 11,
      "UnifiedTierId": 12,
      "PromotionalTierId": 1,
      "IsGeneric": true,
      "PriorAuthorization": true,
      "StepTherapy": true,
      "QuantityLimit": true,
      "SpecialtyPharmacy": true,
      "ConditionalPriorAuthorization": true,
      "DurableMedicalEquipment": true,
      "MedicalBenefit": true,
      "OverTheCounter": true,
      "Variance": true,
      "StateCarveOut": true,
      "FormularyId": 24
    }
  ],
  "SummaryCoverages": [
    {
      "UnifiedTierId": 1,
      "Percentage": 2,
      "Lives": 3,
      "PlanCount": 4
    },
    {
      "UnifiedTierId": 1,
      "Percentage": 2,
      "Lives": 3,
      "PlanCount": 4
    }
  ],
  "Statement": "sample string 1"
}

<ControllerCoveragesResponse xmlns:i="http://www.w3.org/2001/XMLSchema-instance" xmlns="http://api.mmitnetwork.com/formulary/coverages">
  <ControllerCoverages>
    <Coverage>
      <ControllerId>4</ControllerId>
      <DrugListTier>
        <DrugListTierId>64</DrugListTierId>
        <Lives>3</Lives>
        <Percentage>2</Percentage>
        <PlanCount>4</PlanCount>
      </DrugListTier>
      <Lives>6</Lives>
      <MonthId>3</MonthId>
      <PlanCount>7</PlanCount>
      <ProductId>1</ProductId>
      <PromotionalTier>
        <Lives>3</Lives>
        <Percentage>2</Percentage>
        <PlanCount>4</PlanCount>
        <PromotionalTierId>1</PromotionalTierId>
      </PromotionalTier>
      <UnifiedTier>
        <Lives>3</Lives>
        <Percentage>2</Percentage>
        <PlanCount>4</PlanCount>
        <UnifiedTierId>1</UnifiedTierId>
      </UnifiedTier>
    </Coverage>
    <Coverage>
      <ControllerId>4</ControllerId>
      <DrugListTier>
        <DrugListTierId>64</DrugListTierId>
        <Lives>3</Lives>
        <Percentage>2</Percentage>
        <PlanCount>4</PlanCount>
      </DrugListTier>
      <Lives>6</Lives>
      <MonthId>3</MonthId>
      <PlanCount>7</PlanCount>
      <ProductId>1</ProductId>
      <PromotionalTier>
        <Lives>3</Lives>
        <Percentage>2</Percentage>
        <PlanCount>4</PlanCount>
        <PromotionalTierId>1</PromotionalTierId>
      </PromotionalTier>
      <UnifiedTier>
        <Lives>3</Lives>
        <Percentage>2</Percentage>
        <PlanCount>4</PlanCount>
        <UnifiedTierId>1</UnifiedTierId>
      </UnifiedTier>
    </Coverage>
  </ControllerCoverages>
  <PlanCoverages>
    <PlanCoverage>
      <ChannelId>3</ChannelId>
      <ConditionalPriorAuthorization>true</ConditionalPriorAuthorization>
      <ControllerId>6</ControllerId>
      <DrugListTierId>64</DrugListTierId>
      <DurableMedicalEquipment>true</DurableMedicalEquipment>
      <FormularyId>24</FormularyId>
      <FormularyTierId>10</FormularyTierId>
      <FormularyUnifiedTierId>11</FormularyUnifiedTierId>
      <IsGeneric>true</IsGeneric>
      <Lives>8</Lives>
      <MedicalBenefit>true</MedicalBenefit>
      <MonthId>5</MonthId>
      <NoteId>1</NoteId>
      <NotesAvailable>7</NotesAvailable>
      <OverTheCounter>true</OverTheCounter>
      <PlanId>1</PlanId>
      <PlanTypeId>64</PlanTypeId>
      <PriorAuthorization>true</PriorAuthorization>
      <ProductId>4</ProductId>
      <PromotionalTierId>1</PromotionalTierId>
      <QuantityLimit>true</QuantityLimit>
      <SpecialtyPharmacy>true</SpecialtyPharmacy>
      <StateCarveOut>true</StateCarveOut>
      <StepTherapy>true</StepTherapy>
      <UnifiedTierId>12</UnifiedTierId>
      <Variance>true</Variance>
    </PlanCoverage>
    <PlanCoverage>
      <ChannelId>3</ChannelId>
      <ConditionalPriorAuthorization>true</ConditionalPriorAuthorization>
      <ControllerId>6</ControllerId>
      <DrugListTierId>64</DrugListTierId>
      <DurableMedicalEquipment>true</DurableMedicalEquipment>
      <FormularyId>24</FormularyId>
      <FormularyTierId>10</FormularyTierId>
      <FormularyUnifiedTierId>11</FormularyUnifiedTierId>
      <IsGeneric>true</IsGeneric>
      <Lives>8</Lives>
      <MedicalBenefit>true</MedicalBenefit>
      <MonthId>5</MonthId>
      <NoteId>1</NoteId>
      <NotesAvailable>7</NotesAvailable>
      <OverTheCounter>true</OverTheCounter>
      <PlanId>1</PlanId>
      <PlanTypeId>64</PlanTypeId>
      <PriorAuthorization>true</PriorAuthorization>
      <ProductId>4</ProductId>
      <PromotionalTierId>1</PromotionalTierId>
      <QuantityLimit>true</QuantityLimit>
      <SpecialtyPharmacy>true</SpecialtyPharmacy>
      <StateCarveOut>true</StateCarveOut>
      <StepTherapy>true</StepTherapy>
      <UnifiedTierId>12</UnifiedTierId>
      <Variance>true</Variance>
    </PlanCoverage>
  </PlanCoverages>
  <Statement>sample string 1</Statement>
  <SummaryCoverages>
    <UnifiedTierCoverage>
      <Lives>3</Lives>
      <Percentage>2</Percentage>
      <PlanCount>4</PlanCount>
      <UnifiedTierId>1</UnifiedTierId>
    </UnifiedTierCoverage>
    <UnifiedTierCoverage>
      <Lives>3</Lives>
      <Percentage>2</Percentage>
      <PlanCount>4</PlanCount>
      <UnifiedTierId>1</UnifiedTierId>
    </UnifiedTierCoverage>
  </SummaryCoverages>
</ControllerCoveragesResponse>

Build Request


NameDescription Input Value Type Required / Optional
ProductId

The Id of the Product

integer

Required
ControllerId

The Id of the Controller/Parent

integer

Required
BenefitDesignId

The Id of the BenefitDesign used as a Plan filter the response

integer

Optional
ChannelId

The Id of the Channel used as a Plan filter the response

Collection of integer

Optional
PlanTypeId

The Id of the PlanType used as a Plan filter the response

integer

Optional
StateId

The US State Id where the Plan(s) are covered

string

Optional
CBSAId

The CBSA(Service Area) Id where the Plan is covered

integer

Optional
TerritoryId

The Territory Id where the Plan is covered

integer

Optional
Options

Enter "PlanCoverages" to include Plan level coverage in addition to Controller coverage. Enter "SummaryCoverages" to include a summary of all statuses in addition to Controller coverage.

Collection of string

Optional
LivesTypeId

The Id to override the types of lives to shown (Default: 4)

integer

Optional
ApplyNLPolicies

Turns Coverage ON/OFF for NL and NTM policies. When 'PoliciesOn', the policies are applied and when 'PoliciesOff', the policies are turned off.

string

Optional




Request URL

GET Formulary/v1/Coverage/Controller?ProductId=ProductId&ControllerId=ControllerId&BenefitDesignId=BenefitDesignId&ChannelId=ChannelId&PlanTypeId=PlanTypeId&StateId=StateId&CBSAId=CBSAId&TerritoryId=TerritoryId&Options=Options&LivesTypeId=LivesTypeId&ApplyNLPolicies=ApplyNLPolicies

Status

Response Details

Coverage for a specific MCO and Product


Request URL
GET Formulary/v1/Coverage/MCO


URI Parameters

NameDescription Type Required / Optional
ProductId

The Id of the Product

 integer

Required
MCOId

The Id of the MCO

 integer

Required
BenefitDesignId

The Id of the BenefitDesign used as a Plan filter the response

 integer

Optional
ChannelId

The Id of the Channel used as a Plan filter the response

 Collection of integer

Optional
PlanTypeId

The Id of the PlanType used as a Plan filter the response

 integer

Optional
StateId

The US State Id where the Plan(s) are covered

 string

Optional
CBSAId

The CBSA(Service Area) Id where the Plan is covered

 integer

Optional
TerritoryId

The Territory Id where the Plan is covered

 integer

Optional
Options

Enter "PlanCoverages" to include Plan level coverage in addition to MCO coverage. Enter "SummaryCoverages" to include a summary of all statuses in addition to MCO coverage.

 Collection of string

Optional
LivesTypeId

The Id to override the types of lives to shown (Default: 4)

 integer

Optional
ApplyNLPolicies

Turns Coverage ON/OFF for NL and NTM policies. When 'PoliciesOn', the policies are applied and when 'PoliciesOff', the policies are turned off.

 string

Optional

Resource Description of Response Object

McoCoveragesResponse
NameDescription Type Required / Optional
MCOCoverages

Collection of McoCoverage

Optional
PlanCoverages

Collection of PlanMcoCoverage

Optional
SummaryCoverages

Collection of UnifiedTierCoverage

Optional
Statement

string

Optional

Available Response Formats & Sample Data

{
  "MCOCoverages": [
    {
      "ProductId": 1,
      "MonthId": 3,
      "MCOId": 4,
      "MCO": "sample string 5",
      "DrugListTier": {
        "DrugListTierId": 64,
        "Percentage": 2,
        "Lives": 3,
        "PlanCount": 4
      },
      "UnifiedTier": {
        "UnifiedTierId": 1,
        "Percentage": 2,
        "Lives": 3,
        "PlanCount": 4
      },
      "PromotionalTier": {
        "PromotionalTierId": 1,
        "Percentage": 2,
        "Lives": 3,
        "PlanCount": 4
      },
      "Lives": 6,
      "PlanCount": 7
    },
    {
      "ProductId": 1,
      "MonthId": 3,
      "MCOId": 4,
      "MCO": "sample string 5",
      "DrugListTier": {
        "DrugListTierId": 64,
        "Percentage": 2,
        "Lives": 3,
        "PlanCount": 4
      },
      "UnifiedTier": {
        "UnifiedTierId": 1,
        "Percentage": 2,
        "Lives": 3,
        "PlanCount": 4
      },
      "PromotionalTier": {
        "PromotionalTierId": 1,
        "Percentage": 2,
        "Lives": 3,
        "PlanCount": 4
      },
      "Lives": 6,
      "PlanCount": 7
    }
  ],
  "PlanCoverages": [
    {
      "PlanId": 1,
      "PlanTypeId": 64,
      "ChannelId": 3,
      "ProductId": 4,
      "MonthId": 5,
      "MCOId": 6,
      "MCO": "sample string 7",
      "NoteId": 1,
      "NotesAvailable": 8,
      "Lives": 9,
      "DrugListTierId": 64,
      "FormularyTierId": 11,
      "FormularyUnifiedTierId": 12,
      "UnifiedTierId": 13,
      "PromotionalTierId": 1,
      "IsGeneric": true,
      "PriorAuthorization": true,
      "StepTherapy": true,
      "QuantityLimit": true,
      "SpecialtyPharmacy": true,
      "ConditionalPriorAuthorization": true,
      "DurableMedicalEquipment": true,
      "MedicalBenefit": true,
      "OverTheCounter": true,
      "Variance": true,
      "StateCarveOut": true,
      "FormularyId": 25
    },
    {
      "PlanId": 1,
      "PlanTypeId": 64,
      "ChannelId": 3,
      "ProductId": 4,
      "MonthId": 5,
      "MCOId": 6,
      "MCO": "sample string 7",
      "NoteId": 1,
      "NotesAvailable": 8,
      "Lives": 9,
      "DrugListTierId": 64,
      "FormularyTierId": 11,
      "FormularyUnifiedTierId": 12,
      "UnifiedTierId": 13,
      "PromotionalTierId": 1,
      "IsGeneric": true,
      "PriorAuthorization": true,
      "StepTherapy": true,
      "QuantityLimit": true,
      "SpecialtyPharmacy": true,
      "ConditionalPriorAuthorization": true,
      "DurableMedicalEquipment": true,
      "MedicalBenefit": true,
      "OverTheCounter": true,
      "Variance": true,
      "StateCarveOut": true,
      "FormularyId": 25
    }
  ],
  "SummaryCoverages": [
    {
      "UnifiedTierId": 1,
      "Percentage": 2,
      "Lives": 3,
      "PlanCount": 4
    },
    {
      "UnifiedTierId": 1,
      "Percentage": 2,
      "Lives": 3,
      "PlanCount": 4
    }
  ],
  "Statement": "sample string 1"
}

<McoCoveragesResponse xmlns:i="http://www.w3.org/2001/XMLSchema-instance" xmlns="http://api.mmitnetwork.com/formulary/coverages">
  <MCOCoverages>
    <McoCoverage>
      <DrugListTier>
        <DrugListTierId>64</DrugListTierId>
        <Lives>3</Lives>
        <Percentage>2</Percentage>
        <PlanCount>4</PlanCount>
      </DrugListTier>
      <Lives>6</Lives>
      <MCO>sample string 5</MCO>
      <MCOId>4</MCOId>
      <MonthId>3</MonthId>
      <PlanCount>7</PlanCount>
      <ProductId>1</ProductId>
      <PromotionalTier>
        <Lives>3</Lives>
        <Percentage>2</Percentage>
        <PlanCount>4</PlanCount>
        <PromotionalTierId>1</PromotionalTierId>
      </PromotionalTier>
      <UnifiedTier>
        <Lives>3</Lives>
        <Percentage>2</Percentage>
        <PlanCount>4</PlanCount>
        <UnifiedTierId>1</UnifiedTierId>
      </UnifiedTier>
    </McoCoverage>
    <McoCoverage>
      <DrugListTier>
        <DrugListTierId>64</DrugListTierId>
        <Lives>3</Lives>
        <Percentage>2</Percentage>
        <PlanCount>4</PlanCount>
      </DrugListTier>
      <Lives>6</Lives>
      <MCO>sample string 5</MCO>
      <MCOId>4</MCOId>
      <MonthId>3</MonthId>
      <PlanCount>7</PlanCount>
      <ProductId>1</ProductId>
      <PromotionalTier>
        <Lives>3</Lives>
        <Percentage>2</Percentage>
        <PlanCount>4</PlanCount>
        <PromotionalTierId>1</PromotionalTierId>
      </PromotionalTier>
      <UnifiedTier>
        <Lives>3</Lives>
        <Percentage>2</Percentage>
        <PlanCount>4</PlanCount>
        <UnifiedTierId>1</UnifiedTierId>
      </UnifiedTier>
    </McoCoverage>
  </MCOCoverages>
  <PlanCoverages>
    <PlanMcoCoverage>
      <ChannelId>3</ChannelId>
      <ConditionalPriorAuthorization>true</ConditionalPriorAuthorization>
      <DrugListTierId>64</DrugListTierId>
      <DurableMedicalEquipment>true</DurableMedicalEquipment>
      <FormularyId>25</FormularyId>
      <FormularyTierId>11</FormularyTierId>
      <FormularyUnifiedTierId>12</FormularyUnifiedTierId>
      <IsGeneric>true</IsGeneric>
      <Lives>9</Lives>
      <MCO>sample string 7</MCO>
      <MCOId>6</MCOId>
      <MedicalBenefit>true</MedicalBenefit>
      <MonthId>5</MonthId>
      <NoteId>1</NoteId>
      <NotesAvailable>8</NotesAvailable>
      <OverTheCounter>true</OverTheCounter>
      <PlanId>1</PlanId>
      <PlanTypeId>64</PlanTypeId>
      <PriorAuthorization>true</PriorAuthorization>
      <ProductId>4</ProductId>
      <PromotionalTierId>1</PromotionalTierId>
      <QuantityLimit>true</QuantityLimit>
      <SpecialtyPharmacy>true</SpecialtyPharmacy>
      <StateCarveOut>true</StateCarveOut>
      <StepTherapy>true</StepTherapy>
      <UnifiedTierId>13</UnifiedTierId>
      <Variance>true</Variance>
    </PlanMcoCoverage>
    <PlanMcoCoverage>
      <ChannelId>3</ChannelId>
      <ConditionalPriorAuthorization>true</ConditionalPriorAuthorization>
      <DrugListTierId>64</DrugListTierId>
      <DurableMedicalEquipment>true</DurableMedicalEquipment>
      <FormularyId>25</FormularyId>
      <FormularyTierId>11</FormularyTierId>
      <FormularyUnifiedTierId>12</FormularyUnifiedTierId>
      <IsGeneric>true</IsGeneric>
      <Lives>9</Lives>
      <MCO>sample string 7</MCO>
      <MCOId>6</MCOId>
      <MedicalBenefit>true</MedicalBenefit>
      <MonthId>5</MonthId>
      <NoteId>1</NoteId>
      <NotesAvailable>8</NotesAvailable>
      <OverTheCounter>true</OverTheCounter>
      <PlanId>1</PlanId>
      <PlanTypeId>64</PlanTypeId>
      <PriorAuthorization>true</PriorAuthorization>
      <ProductId>4</ProductId>
      <PromotionalTierId>1</PromotionalTierId>
      <QuantityLimit>true</QuantityLimit>
      <SpecialtyPharmacy>true</SpecialtyPharmacy>
      <StateCarveOut>true</StateCarveOut>
      <StepTherapy>true</StepTherapy>
      <UnifiedTierId>13</UnifiedTierId>
      <Variance>true</Variance>
    </PlanMcoCoverage>
  </PlanCoverages>
  <Statement>sample string 1</Statement>
  <SummaryCoverages>
    <UnifiedTierCoverage>
      <Lives>3</Lives>
      <Percentage>2</Percentage>
      <PlanCount>4</PlanCount>
      <UnifiedTierId>1</UnifiedTierId>
    </UnifiedTierCoverage>
    <UnifiedTierCoverage>
      <Lives>3</Lives>
      <Percentage>2</Percentage>
      <PlanCount>4</PlanCount>
      <UnifiedTierId>1</UnifiedTierId>
    </UnifiedTierCoverage>
  </SummaryCoverages>
</McoCoveragesResponse>

Build Request


NameDescription Input Value Type Required / Optional
ProductId

The Id of the Product

integer

Required
MCOId

The Id of the MCO

integer

Required
BenefitDesignId

The Id of the BenefitDesign used as a Plan filter the response

integer

Optional
ChannelId

The Id of the Channel used as a Plan filter the response

Collection of integer

Optional
PlanTypeId

The Id of the PlanType used as a Plan filter the response

integer

Optional
StateId

The US State Id where the Plan(s) are covered

string

Optional
CBSAId

The CBSA(Service Area) Id where the Plan is covered

integer

Optional
TerritoryId

The Territory Id where the Plan is covered

integer

Optional
Options

Enter "PlanCoverages" to include Plan level coverage in addition to MCO coverage. Enter "SummaryCoverages" to include a summary of all statuses in addition to MCO coverage.

Collection of string

Optional
LivesTypeId

The Id to override the types of lives to shown (Default: 4)

integer

Optional
ApplyNLPolicies

Turns Coverage ON/OFF for NL and NTM policies. When 'PoliciesOn', the policies are applied and when 'PoliciesOff', the policies are turned off.

string

Optional




Request URL

GET Formulary/v1/Coverage/MCO?ProductId=ProductId&MCOId=MCOId&BenefitDesignId=BenefitDesignId&ChannelId=ChannelId&PlanTypeId=PlanTypeId&StateId=StateId&CBSAId=CBSAId&TerritoryId=TerritoryId&Options=Options&LivesTypeId=LivesTypeId&ApplyNLPolicies=ApplyNLPolicies

Status

Response Details

Alternative Coverage for a specific Controller and Product


Request URL
GET Formulary/v1/Coverage/Controller/Alternatives


URI Parameters

NameDescription Type Required / Optional
ProductId

The Id of the Product

 integer

Required
ControllerId

The Id of the Controller/Parent

 integer

Required
BenefitDesignId

The Id of the BenefitDesign used as a Plan filter the response

 integer

Optional
ChannelId

The Id of the Channel used as a Plan filter the response

 Collection of integer

Optional
PlanTypeId

The Id of the PlanType used as a Plan filter the response

 integer

Optional
StateId

The US State Id where the Plan(s) are covered

 string

Optional
CBSAId

The CBSA(Service Area) Id where the Plan is covered

 integer

Optional
TerritoryId

The Territory Id where the Plan is covered

 integer

Optional
DrugTypeId

The DrugTypeId of the Product to be returned

 byte

Optional
Options

Enter "PlanCoverages" to include Plan level coverage in addition to Controller coverage. Enter "SummaryCoverages" to include a summary of all statuses in addition to Controller coverage.

 Collection of string

Optional
LivesTypeId

The Id to override the types of lives to shown (Default: 4)

 integer

Optional
ApplyNLPolicies

Turns Coverage ON/OFF for NL and NTM policies. When 'PoliciesOn', the policies are applied and when 'PoliciesOff', the policies are turned off.

 string

Optional

Resource Description of Response Object

AlternativeControllerCoveragesResponse
NameDescription Type Required / Optional
ControllerCoverages

Collection of Coverage

Optional
PlanCoverages

Collection of PlanCoverage

Optional
Products

Collection of Product

Optional
SummaryCoverages

Collection of UnifiedTierCoverage

Optional

Available Response Formats & Sample Data

{
  "ControllerCoverages": [
    {
      "ProductId": 1,
      "MonthId": 3,
      "ControllerId": 4,
      "DrugListTier": {
        "DrugListTierId": 64,
        "Percentage": 2,
        "Lives": 3,
        "PlanCount": 4
      },
      "UnifiedTier": {
        "UnifiedTierId": 1,
        "Percentage": 2,
        "Lives": 3,
        "PlanCount": 4
      },
      "PromotionalTier": {
        "PromotionalTierId": 1,
        "Percentage": 2,
        "Lives": 3,
        "PlanCount": 4
      },
      "Lives": 6,
      "PlanCount": 7
    },
    {
      "ProductId": 1,
      "MonthId": 3,
      "ControllerId": 4,
      "DrugListTier": {
        "DrugListTierId": 64,
        "Percentage": 2,
        "Lives": 3,
        "PlanCount": 4
      },
      "UnifiedTier": {
        "UnifiedTierId": 1,
        "Percentage": 2,
        "Lives": 3,
        "PlanCount": 4
      },
      "PromotionalTier": {
        "PromotionalTierId": 1,
        "Percentage": 2,
        "Lives": 3,
        "PlanCount": 4
      },
      "Lives": 6,
      "PlanCount": 7
    }
  ],
  "PlanCoverages": [
    {
      "PlanId": 1,
      "PlanTypeId": 64,
      "ChannelId": 3,
      "ProductId": 4,
      "MonthId": 5,
      "ControllerId": 6,
      "NoteId": 1,
      "NotesAvailable": 7,
      "Lives": 8,
      "DrugListTierId": 64,
      "FormularyTierId": 10,
      "FormularyUnifiedTierId": 11,
      "UnifiedTierId": 12,
      "PromotionalTierId": 1,
      "IsGeneric": true,
      "PriorAuthorization": true,
      "StepTherapy": true,
      "QuantityLimit": true,
      "SpecialtyPharmacy": true,
      "ConditionalPriorAuthorization": true,
      "DurableMedicalEquipment": true,
      "MedicalBenefit": true,
      "OverTheCounter": true,
      "Variance": true,
      "StateCarveOut": true,
      "FormularyId": 24
    },
    {
      "PlanId": 1,
      "PlanTypeId": 64,
      "ChannelId": 3,
      "ProductId": 4,
      "MonthId": 5,
      "ControllerId": 6,
      "NoteId": 1,
      "NotesAvailable": 7,
      "Lives": 8,
      "DrugListTierId": 64,
      "FormularyTierId": 10,
      "FormularyUnifiedTierId": 11,
      "UnifiedTierId": 12,
      "PromotionalTierId": 1,
      "IsGeneric": true,
      "PriorAuthorization": true,
      "StepTherapy": true,
      "QuantityLimit": true,
      "SpecialtyPharmacy": true,
      "ConditionalPriorAuthorization": true,
      "DurableMedicalEquipment": true,
      "MedicalBenefit": true,
      "OverTheCounter": true,
      "Variance": true,
      "StateCarveOut": true,
      "FormularyId": 24
    }
  ],
  "Products": [
    {
      "ProductId": 1,
      "TherapeuticClassId": 2,
      "TherapeuticClass": "sample string 3",
      "Drug": {
        "DrugId": 1,
        "DrugTypeId": 64,
        "Name": "sample string 3",
        "Description": "sample string 4",
        "Brand": "sample string 5",
        "IsGeneric": true,
        "OverTheCounter": true,
        "IsOwner": true,
        "Logo": "sample string 8",
        "ImportantSafetyInformation": "sample string 9",
        "Rank": 64
      },
      "DisplayName": "sample string 4"
    },
    {
      "ProductId": 1,
      "TherapeuticClassId": 2,
      "TherapeuticClass": "sample string 3",
      "Drug": {
        "DrugId": 1,
        "DrugTypeId": 64,
        "Name": "sample string 3",
        "Description": "sample string 4",
        "Brand": "sample string 5",
        "IsGeneric": true,
        "OverTheCounter": true,
        "IsOwner": true,
        "Logo": "sample string 8",
        "ImportantSafetyInformation": "sample string 9",
        "Rank": 64
      },
      "DisplayName": "sample string 4"
    }
  ],
  "SummaryCoverages": [
    {
      "UnifiedTierId": 1,
      "Percentage": 2,
      "Lives": 3,
      "PlanCount": 4
    },
    {
      "UnifiedTierId": 1,
      "Percentage": 2,
      "Lives": 3,
      "PlanCount": 4
    }
  ]
}

<AlternativeControllerCoveragesResponse xmlns:i="http://www.w3.org/2001/XMLSchema-instance" xmlns="http://api.mmitnetwork.com/formulary/coverages">
  <ControllerCoverages>
    <Coverage>
      <ControllerId>4</ControllerId>
      <DrugListTier>
        <DrugListTierId>64</DrugListTierId>
        <Lives>3</Lives>
        <Percentage>2</Percentage>
        <PlanCount>4</PlanCount>
      </DrugListTier>
      <Lives>6</Lives>
      <MonthId>3</MonthId>
      <PlanCount>7</PlanCount>
      <ProductId>1</ProductId>
      <PromotionalTier>
        <Lives>3</Lives>
        <Percentage>2</Percentage>
        <PlanCount>4</PlanCount>
        <PromotionalTierId>1</PromotionalTierId>
      </PromotionalTier>
      <UnifiedTier>
        <Lives>3</Lives>
        <Percentage>2</Percentage>
        <PlanCount>4</PlanCount>
        <UnifiedTierId>1</UnifiedTierId>
      </UnifiedTier>
    </Coverage>
    <Coverage>
      <ControllerId>4</ControllerId>
      <DrugListTier>
        <DrugListTierId>64</DrugListTierId>
        <Lives>3</Lives>
        <Percentage>2</Percentage>
        <PlanCount>4</PlanCount>
      </DrugListTier>
      <Lives>6</Lives>
      <MonthId>3</MonthId>
      <PlanCount>7</PlanCount>
      <ProductId>1</ProductId>
      <PromotionalTier>
        <Lives>3</Lives>
        <Percentage>2</Percentage>
        <PlanCount>4</PlanCount>
        <PromotionalTierId>1</PromotionalTierId>
      </PromotionalTier>
      <UnifiedTier>
        <Lives>3</Lives>
        <Percentage>2</Percentage>
        <PlanCount>4</PlanCount>
        <UnifiedTierId>1</UnifiedTierId>
      </UnifiedTier>
    </Coverage>
  </ControllerCoverages>
  <PlanCoverages>
    <PlanCoverage>
      <ChannelId>3</ChannelId>
      <ConditionalPriorAuthorization>true</ConditionalPriorAuthorization>
      <ControllerId>6</ControllerId>
      <DrugListTierId>64</DrugListTierId>
      <DurableMedicalEquipment>true</DurableMedicalEquipment>
      <FormularyId>24</FormularyId>
      <FormularyTierId>10</FormularyTierId>
      <FormularyUnifiedTierId>11</FormularyUnifiedTierId>
      <IsGeneric>true</IsGeneric>
      <Lives>8</Lives>
      <MedicalBenefit>true</MedicalBenefit>
      <MonthId>5</MonthId>
      <NoteId>1</NoteId>
      <NotesAvailable>7</NotesAvailable>
      <OverTheCounter>true</OverTheCounter>
      <PlanId>1</PlanId>
      <PlanTypeId>64</PlanTypeId>
      <PriorAuthorization>true</PriorAuthorization>
      <ProductId>4</ProductId>
      <PromotionalTierId>1</PromotionalTierId>
      <QuantityLimit>true</QuantityLimit>
      <SpecialtyPharmacy>true</SpecialtyPharmacy>
      <StateCarveOut>true</StateCarveOut>
      <StepTherapy>true</StepTherapy>
      <UnifiedTierId>12</UnifiedTierId>
      <Variance>true</Variance>
    </PlanCoverage>
    <PlanCoverage>
      <ChannelId>3</ChannelId>
      <ConditionalPriorAuthorization>true</ConditionalPriorAuthorization>
      <ControllerId>6</ControllerId>
      <DrugListTierId>64</DrugListTierId>
      <DurableMedicalEquipment>true</DurableMedicalEquipment>
      <FormularyId>24</FormularyId>
      <FormularyTierId>10</FormularyTierId>
      <FormularyUnifiedTierId>11</FormularyUnifiedTierId>
      <IsGeneric>true</IsGeneric>
      <Lives>8</Lives>
      <MedicalBenefit>true</MedicalBenefit>
      <MonthId>5</MonthId>
      <NoteId>1</NoteId>
      <NotesAvailable>7</NotesAvailable>
      <OverTheCounter>true</OverTheCounter>
      <PlanId>1</PlanId>
      <PlanTypeId>64</PlanTypeId>
      <PriorAuthorization>true</PriorAuthorization>
      <ProductId>4</ProductId>
      <PromotionalTierId>1</PromotionalTierId>
      <QuantityLimit>true</QuantityLimit>
      <SpecialtyPharmacy>true</SpecialtyPharmacy>
      <StateCarveOut>true</StateCarveOut>
      <StepTherapy>true</StepTherapy>
      <UnifiedTierId>12</UnifiedTierId>
      <Variance>true</Variance>
    </PlanCoverage>
  </PlanCoverages>
  <Products xmlns:d2p1="http://api.mmitnetwork.com/formulary/products">
    <d2p1:Product>
      <d2p1:DisplayName>sample string 4</d2p1:DisplayName>
      <d2p1:Drug>
        <d2p1:Brand>sample string 5</d2p1:Brand>
        <d2p1:Description>sample string 4</d2p1:Description>
        <d2p1:DrugId>1</d2p1:DrugId>
        <d2p1:DrugTypeId>64</d2p1:DrugTypeId>
        <d2p1:ImportantSafetyInformation>sample string 9</d2p1:ImportantSafetyInformation>
        <d2p1:IsGeneric>true</d2p1:IsGeneric>
        <d2p1:IsOwner>true</d2p1:IsOwner>
        <d2p1:Logo>sample string 8</d2p1:Logo>
        <d2p1:Name>sample string 3</d2p1:Name>
        <d2p1:OverTheCounter>true</d2p1:OverTheCounter>
        <d2p1:Rank>64</d2p1:Rank>
      </d2p1:Drug>
      <d2p1:ProductId>1</d2p1:ProductId>
      <d2p1:TherapeuticClass>sample string 3</d2p1:TherapeuticClass>
      <d2p1:TherapeuticClassId>2</d2p1:TherapeuticClassId>
    </d2p1:Product>
    <d2p1:Product>
      <d2p1:DisplayName>sample string 4</d2p1:DisplayName>
      <d2p1:Drug>
        <d2p1:Brand>sample string 5</d2p1:Brand>
        <d2p1:Description>sample string 4</d2p1:Description>
        <d2p1:DrugId>1</d2p1:DrugId>
        <d2p1:DrugTypeId>64</d2p1:DrugTypeId>
        <d2p1:ImportantSafetyInformation>sample string 9</d2p1:ImportantSafetyInformation>
        <d2p1:IsGeneric>true</d2p1:IsGeneric>
        <d2p1:IsOwner>true</d2p1:IsOwner>
        <d2p1:Logo>sample string 8</d2p1:Logo>
        <d2p1:Name>sample string 3</d2p1:Name>
        <d2p1:OverTheCounter>true</d2p1:OverTheCounter>
        <d2p1:Rank>64</d2p1:Rank>
      </d2p1:Drug>
      <d2p1:ProductId>1</d2p1:ProductId>
      <d2p1:TherapeuticClass>sample string 3</d2p1:TherapeuticClass>
      <d2p1:TherapeuticClassId>2</d2p1:TherapeuticClassId>
    </d2p1:Product>
  </Products>
  <SummaryCoverages>
    <UnifiedTierCoverage>
      <Lives>3</Lives>
      <Percentage>2</Percentage>
      <PlanCount>4</PlanCount>
      <UnifiedTierId>1</UnifiedTierId>
    </UnifiedTierCoverage>
    <UnifiedTierCoverage>
      <Lives>3</Lives>
      <Percentage>2</Percentage>
      <PlanCount>4</PlanCount>
      <UnifiedTierId>1</UnifiedTierId>
    </UnifiedTierCoverage>
  </SummaryCoverages>
</AlternativeControllerCoveragesResponse>

Build Request


NameDescription Input Value Type Required / Optional
ProductId

The Id of the Product

integer

Required
ControllerId

The Id of the Controller/Parent

integer

Required
BenefitDesignId

The Id of the BenefitDesign used as a Plan filter the response

integer

Optional
ChannelId

The Id of the Channel used as a Plan filter the response

Collection of integer

Optional
PlanTypeId

The Id of the PlanType used as a Plan filter the response

integer

Optional
StateId

The US State Id where the Plan(s) are covered

string

Optional
CBSAId

The CBSA(Service Area) Id where the Plan is covered

integer

Optional
TerritoryId

The Territory Id where the Plan is covered

integer

Optional
DrugTypeId

The DrugTypeId of the Product to be returned

byte

Optional
Options

Enter "PlanCoverages" to include Plan level coverage in addition to Controller coverage. Enter "SummaryCoverages" to include a summary of all statuses in addition to Controller coverage.

Collection of string

Optional
LivesTypeId

The Id to override the types of lives to shown (Default: 4)

integer

Optional
ApplyNLPolicies

Turns Coverage ON/OFF for NL and NTM policies. When 'PoliciesOn', the policies are applied and when 'PoliciesOff', the policies are turned off.

string

Optional




Request URL

GET Formulary/v1/Coverage/Controller/Alternatives?ProductId=ProductId&ControllerId=ControllerId&BenefitDesignId=BenefitDesignId&ChannelId=ChannelId&PlanTypeId=PlanTypeId&StateId=StateId&CBSAId=CBSAId&TerritoryId=TerritoryId&DrugTypeId=DrugTypeId&Options=Options&LivesTypeId=LivesTypeId&ApplyNLPolicies=ApplyNLPolicies

Status

Response Details

Alternative Coverage for a specific MCO and Product


Request URL
GET Formulary/v1/Coverage/MCO/Alternatives


URI Parameters

NameDescription Type Required / Optional
ProductId

The Id of the Product

 integer

Required
MCOId

The Id of the MCO

 integer

Required
BenefitDesignId

The Id of the BenefitDesign used as a Plan filter the response

 integer

Optional
ChannelId

The Id of the Channel used as a Plan filter the response

 Collection of integer

Optional
PlanTypeId

The Id of the PlanType used as a Plan filter the response

 integer

Optional
StateId

The US State Id where the Plan(s) are covered

 string

Optional
CBSAId

The CBSA(Service Area) Id where the Plan is covered

 integer

Optional
TerritoryId

The Territory Id where the Plan is covered

 integer

Optional
DrugTypeId

The DrugTypeId of the Product to be returned

 byte

Optional
Options

Enter "PlanCoverages" to include Plan level coverage in addition to MCO coverage. Enter "SummaryCoverages" to include a summary of all statuses in addition to MCO coverage.

 Collection of string

Optional
LivesTypeId

The Id to override the types of lives to shown (Default: 4)

 integer

Optional
ApplyNLPolicies

Turns Coverage ON/OFF for NL and NTM policies. When 'PoliciesOn', the policies are applied and when 'PoliciesOff', the policies are turned off.

 string

Optional

Resource Description of Response Object

AlternativeMcoCoveragesResponse
NameDescription Type Required / Optional
McoCoverages

Collection of McoCoverage

Optional
PlanCoverages

Collection of PlanMcoCoverage

Optional
Products

Collection of Product

Optional
SummaryCoverages

Collection of UnifiedTierCoverage

Optional

Available Response Formats & Sample Data

{
  "McoCoverages": [
    {
      "ProductId": 1,
      "MonthId": 3,
      "MCOId": 4,
      "MCO": "sample string 5",
      "DrugListTier": {
        "DrugListTierId": 64,
        "Percentage": 2,
        "Lives": 3,
        "PlanCount": 4
      },
      "UnifiedTier": {
        "UnifiedTierId": 1,
        "Percentage": 2,
        "Lives": 3,
        "PlanCount": 4
      },
      "PromotionalTier": {
        "PromotionalTierId": 1,
        "Percentage": 2,
        "Lives": 3,
        "PlanCount": 4
      },
      "Lives": 6,
      "PlanCount": 7
    },
    {
      "ProductId": 1,
      "MonthId": 3,
      "MCOId": 4,
      "MCO": "sample string 5",
      "DrugListTier": {
        "DrugListTierId": 64,
        "Percentage": 2,
        "Lives": 3,
        "PlanCount": 4
      },
      "UnifiedTier": {
        "UnifiedTierId": 1,
        "Percentage": 2,
        "Lives": 3,
        "PlanCount": 4
      },
      "PromotionalTier": {
        "PromotionalTierId": 1,
        "Percentage": 2,
        "Lives": 3,
        "PlanCount": 4
      },
      "Lives": 6,
      "PlanCount": 7
    }
  ],
  "PlanCoverages": [
    {
      "PlanId": 1,
      "PlanTypeId": 64,
      "ChannelId": 3,
      "ProductId": 4,
      "MonthId": 5,
      "MCOId": 6,
      "MCO": "sample string 7",
      "NoteId": 1,
      "NotesAvailable": 8,
      "Lives": 9,
      "DrugListTierId": 64,
      "FormularyTierId": 11,
      "FormularyUnifiedTierId": 12,
      "UnifiedTierId": 13,
      "PromotionalTierId": 1,
      "IsGeneric": true,
      "PriorAuthorization": true,
      "StepTherapy": true,
      "QuantityLimit": true,
      "SpecialtyPharmacy": true,
      "ConditionalPriorAuthorization": true,
      "DurableMedicalEquipment": true,
      "MedicalBenefit": true,
      "OverTheCounter": true,
      "Variance": true,
      "StateCarveOut": true,
      "FormularyId": 25
    },
    {
      "PlanId": 1,
      "PlanTypeId": 64,
      "ChannelId": 3,
      "ProductId": 4,
      "MonthId": 5,
      "MCOId": 6,
      "MCO": "sample string 7",
      "NoteId": 1,
      "NotesAvailable": 8,
      "Lives": 9,
      "DrugListTierId": 64,
      "FormularyTierId": 11,
      "FormularyUnifiedTierId": 12,
      "UnifiedTierId": 13,
      "PromotionalTierId": 1,
      "IsGeneric": true,
      "PriorAuthorization": true,
      "StepTherapy": true,
      "QuantityLimit": true,
      "SpecialtyPharmacy": true,
      "ConditionalPriorAuthorization": true,
      "DurableMedicalEquipment": true,
      "MedicalBenefit": true,
      "OverTheCounter": true,
      "Variance": true,
      "StateCarveOut": true,
      "FormularyId": 25
    }
  ],
  "Products": [
    {
      "ProductId": 1,
      "TherapeuticClassId": 2,
      "TherapeuticClass": "sample string 3",
      "Drug": {
        "DrugId": 1,
        "DrugTypeId": 64,
        "Name": "sample string 3",
        "Description": "sample string 4",
        "Brand": "sample string 5",
        "IsGeneric": true,
        "OverTheCounter": true,
        "IsOwner": true,
        "Logo": "sample string 8",
        "ImportantSafetyInformation": "sample string 9",
        "Rank": 64
      },
      "DisplayName": "sample string 4"
    },
    {
      "ProductId": 1,
      "TherapeuticClassId": 2,
      "TherapeuticClass": "sample string 3",
      "Drug": {
        "DrugId": 1,
        "DrugTypeId": 64,
        "Name": "sample string 3",
        "Description": "sample string 4",
        "Brand": "sample string 5",
        "IsGeneric": true,
        "OverTheCounter": true,
        "IsOwner": true,
        "Logo": "sample string 8",
        "ImportantSafetyInformation": "sample string 9",
        "Rank": 64
      },
      "DisplayName": "sample string 4"
    }
  ],
  "SummaryCoverages": [
    {
      "UnifiedTierId": 1,
      "Percentage": 2,
      "Lives": 3,
      "PlanCount": 4
    },
    {
      "UnifiedTierId": 1,
      "Percentage": 2,
      "Lives": 3,
      "PlanCount": 4
    }
  ]
}

<AlternativeMcoCoveragesResponse xmlns:i="http://www.w3.org/2001/XMLSchema-instance" xmlns="http://api.mmitnetwork.com/formulary/coverages">
  <McoCoverages>
    <McoCoverage>
      <DrugListTier>
        <DrugListTierId>64</DrugListTierId>
        <Lives>3</Lives>
        <Percentage>2</Percentage>
        <PlanCount>4</PlanCount>
      </DrugListTier>
      <Lives>6</Lives>
      <MCO>sample string 5</MCO>
      <MCOId>4</MCOId>
      <MonthId>3</MonthId>
      <PlanCount>7</PlanCount>
      <ProductId>1</ProductId>
      <PromotionalTier>
        <Lives>3</Lives>
        <Percentage>2</Percentage>
        <PlanCount>4</PlanCount>
        <PromotionalTierId>1</PromotionalTierId>
      </PromotionalTier>
      <UnifiedTier>
        <Lives>3</Lives>
        <Percentage>2</Percentage>
        <PlanCount>4</PlanCount>
        <UnifiedTierId>1</UnifiedTierId>
      </UnifiedTier>
    </McoCoverage>
    <McoCoverage>
      <DrugListTier>
        <DrugListTierId>64</DrugListTierId>
        <Lives>3</Lives>
        <Percentage>2</Percentage>
        <PlanCount>4</PlanCount>
      </DrugListTier>
      <Lives>6</Lives>
      <MCO>sample string 5</MCO>
      <MCOId>4</MCOId>
      <MonthId>3</MonthId>
      <PlanCount>7</PlanCount>
      <ProductId>1</ProductId>
      <PromotionalTier>
        <Lives>3</Lives>
        <Percentage>2</Percentage>
        <PlanCount>4</PlanCount>
        <PromotionalTierId>1</PromotionalTierId>
      </PromotionalTier>
      <UnifiedTier>
        <Lives>3</Lives>
        <Percentage>2</Percentage>
        <PlanCount>4</PlanCount>
        <UnifiedTierId>1</UnifiedTierId>
      </UnifiedTier>
    </McoCoverage>
  </McoCoverages>
  <PlanCoverages>
    <PlanMcoCoverage>
      <ChannelId>3</ChannelId>
      <ConditionalPriorAuthorization>true</ConditionalPriorAuthorization>
      <DrugListTierId>64</DrugListTierId>
      <DurableMedicalEquipment>true</DurableMedicalEquipment>
      <FormularyId>25</FormularyId>
      <FormularyTierId>11</FormularyTierId>
      <FormularyUnifiedTierId>12</FormularyUnifiedTierId>
      <IsGeneric>true</IsGeneric>
      <Lives>9</Lives>
      <MCO>sample string 7</MCO>
      <MCOId>6</MCOId>
      <MedicalBenefit>true</MedicalBenefit>
      <MonthId>5</MonthId>
      <NoteId>1</NoteId>
      <NotesAvailable>8</NotesAvailable>
      <OverTheCounter>true</OverTheCounter>
      <PlanId>1</PlanId>
      <PlanTypeId>64</PlanTypeId>
      <PriorAuthorization>true</PriorAuthorization>
      <ProductId>4</ProductId>
      <PromotionalTierId>1</PromotionalTierId>
      <QuantityLimit>true</QuantityLimit>
      <SpecialtyPharmacy>true</SpecialtyPharmacy>
      <StateCarveOut>true</StateCarveOut>
      <StepTherapy>true</StepTherapy>
      <UnifiedTierId>13</UnifiedTierId>
      <Variance>true</Variance>
    </PlanMcoCoverage>
    <PlanMcoCoverage>
      <ChannelId>3</ChannelId>
      <ConditionalPriorAuthorization>true</ConditionalPriorAuthorization>
      <DrugListTierId>64</DrugListTierId>
      <DurableMedicalEquipment>true</DurableMedicalEquipment>
      <FormularyId>25</FormularyId>
      <FormularyTierId>11</FormularyTierId>
      <FormularyUnifiedTierId>12</FormularyUnifiedTierId>
      <IsGeneric>true</IsGeneric>
      <Lives>9</Lives>
      <MCO>sample string 7</MCO>
      <MCOId>6</MCOId>
      <MedicalBenefit>true</MedicalBenefit>
      <MonthId>5</MonthId>
      <NoteId>1</NoteId>
      <NotesAvailable>8</NotesAvailable>
      <OverTheCounter>true</OverTheCounter>
      <PlanId>1</PlanId>
      <PlanTypeId>64</PlanTypeId>
      <PriorAuthorization>true</PriorAuthorization>
      <ProductId>4</ProductId>
      <PromotionalTierId>1</PromotionalTierId>
      <QuantityLimit>true</QuantityLimit>
      <SpecialtyPharmacy>true</SpecialtyPharmacy>
      <StateCarveOut>true</StateCarveOut>
      <StepTherapy>true</StepTherapy>
      <UnifiedTierId>13</UnifiedTierId>
      <Variance>true</Variance>
    </PlanMcoCoverage>
  </PlanCoverages>
  <Products xmlns:d2p1="http://api.mmitnetwork.com/formulary/products">
    <d2p1:Product>
      <d2p1:DisplayName>sample string 4</d2p1:DisplayName>
      <d2p1:Drug>
        <d2p1:Brand>sample string 5</d2p1:Brand>
        <d2p1:Description>sample string 4</d2p1:Description>
        <d2p1:DrugId>1</d2p1:DrugId>
        <d2p1:DrugTypeId>64</d2p1:DrugTypeId>
        <d2p1:ImportantSafetyInformation>sample string 9</d2p1:ImportantSafetyInformation>
        <d2p1:IsGeneric>true</d2p1:IsGeneric>
        <d2p1:IsOwner>true</d2p1:IsOwner>
        <d2p1:Logo>sample string 8</d2p1:Logo>
        <d2p1:Name>sample string 3</d2p1:Name>
        <d2p1:OverTheCounter>true</d2p1:OverTheCounter>
        <d2p1:Rank>64</d2p1:Rank>
      </d2p1:Drug>
      <d2p1:ProductId>1</d2p1:ProductId>
      <d2p1:TherapeuticClass>sample string 3</d2p1:TherapeuticClass>
      <d2p1:TherapeuticClassId>2</d2p1:TherapeuticClassId>
    </d2p1:Product>
    <d2p1:Product>
      <d2p1:DisplayName>sample string 4</d2p1:DisplayName>
      <d2p1:Drug>
        <d2p1:Brand>sample string 5</d2p1:Brand>
        <d2p1:Description>sample string 4</d2p1:Description>
        <d2p1:DrugId>1</d2p1:DrugId>
        <d2p1:DrugTypeId>64</d2p1:DrugTypeId>
        <d2p1:ImportantSafetyInformation>sample string 9</d2p1:ImportantSafetyInformation>
        <d2p1:IsGeneric>true</d2p1:IsGeneric>
        <d2p1:IsOwner>true</d2p1:IsOwner>
        <d2p1:Logo>sample string 8</d2p1:Logo>
        <d2p1:Name>sample string 3</d2p1:Name>
        <d2p1:OverTheCounter>true</d2p1:OverTheCounter>
        <d2p1:Rank>64</d2p1:Rank>
      </d2p1:Drug>
      <d2p1:ProductId>1</d2p1:ProductId>
      <d2p1:TherapeuticClass>sample string 3</d2p1:TherapeuticClass>
      <d2p1:TherapeuticClassId>2</d2p1:TherapeuticClassId>
    </d2p1:Product>
  </Products>
  <SummaryCoverages>
    <UnifiedTierCoverage>
      <Lives>3</Lives>
      <Percentage>2</Percentage>
      <PlanCount>4</PlanCount>
      <UnifiedTierId>1</UnifiedTierId>
    </UnifiedTierCoverage>
    <UnifiedTierCoverage>
      <Lives>3</Lives>
      <Percentage>2</Percentage>
      <PlanCount>4</PlanCount>
      <UnifiedTierId>1</UnifiedTierId>
    </UnifiedTierCoverage>
  </SummaryCoverages>
</AlternativeMcoCoveragesResponse>

Build Request


NameDescription Input Value Type Required / Optional
ProductId

The Id of the Product

integer

Required
MCOId

The Id of the MCO

integer

Required
BenefitDesignId

The Id of the BenefitDesign used as a Plan filter the response

integer

Optional
ChannelId

The Id of the Channel used as a Plan filter the response

Collection of integer

Optional
PlanTypeId

The Id of the PlanType used as a Plan filter the response

integer

Optional
StateId

The US State Id where the Plan(s) are covered

string

Optional
CBSAId

The CBSA(Service Area) Id where the Plan is covered

integer

Optional
TerritoryId

The Territory Id where the Plan is covered

integer

Optional
DrugTypeId

The DrugTypeId of the Product to be returned

byte

Optional
Options

Enter "PlanCoverages" to include Plan level coverage in addition to MCO coverage. Enter "SummaryCoverages" to include a summary of all statuses in addition to MCO coverage.

Collection of string

Optional
LivesTypeId

The Id to override the types of lives to shown (Default: 4)

integer

Optional
ApplyNLPolicies

Turns Coverage ON/OFF for NL and NTM policies. When 'PoliciesOn', the policies are applied and when 'PoliciesOff', the policies are turned off.

string

Optional




Request URL

GET Formulary/v1/Coverage/MCO/Alternatives?ProductId=ProductId&MCOId=MCOId&BenefitDesignId=BenefitDesignId&ChannelId=ChannelId&PlanTypeId=PlanTypeId&StateId=StateId&CBSAId=CBSAId&TerritoryId=TerritoryId&DrugTypeId=DrugTypeId&Options=Options&LivesTypeId=LivesTypeId&ApplyNLPolicies=ApplyNLPolicies

Status

Response Details

Coverage by Product


Request URL
GET Formulary/v1/Coverage


URI Parameters

NameDescription Type Required / Optional
ProductId

The Id of the Product

 integer

Required
BenefitDesignId

The Id of the BenefitDesign used as a Plan filter the response

 integer

Optional
ChannelId

The Id of the Channel used as a Plan filter the response

 Collection of integer

Optional
PlanTypeId

The Id of the PlanType used as a Plan filter the response

 integer

Optional
StateId

The US State Id where the Plan(s) are covered

 string

Optional
CBSAId

The CBSA(Service Area) Id where the Plan is covered

 integer

Optional
TerritoryId

The Territory Id where the Plan is covered

 integer

Optional
Options

Enter "PlanCoverages" to include Plan level coverage in addition to Controller coverage. Enter "SummaryCoverages" to include a summary of all statuses in addition to Controller coverage.

 Collection of string

Optional
LivesTypeId

The Id to override the types of lives to shown (Default: 4)

 integer

Optional
SummaryUseFormTrakControllerExclusions

Set to true to exclude FormTrak excluded controllers (Default: false)

 boolean

Default value is False
StatusMapping

Please contact support for various options available

 string

Optional
ApplyNLPolicies

Turns Coverage ON/OFF for NL and NTM policies. When 'PoliciesOn', the policies are applied and when 'PoliciesOff', the policies are turned off.

 string

Optional

Resource Description of Response Object

ControllerCoveragesResponse
NameDescription Type Required / Optional
ControllerCoverages

Collection of Coverage

Optional
PlanCoverages

Collection of PlanCoverage

Optional
SummaryCoverages

Collection of UnifiedTierCoverage

Optional
Statement

string

Optional

Available Response Formats & Sample Data

{
  "ControllerCoverages": [
    {
      "ProductId": 1,
      "MonthId": 3,
      "ControllerId": 4,
      "DrugListTier": {
        "DrugListTierId": 64,
        "Percentage": 2,
        "Lives": 3,
        "PlanCount": 4
      },
      "UnifiedTier": {
        "UnifiedTierId": 1,
        "Percentage": 2,
        "Lives": 3,
        "PlanCount": 4
      },
      "PromotionalTier": {
        "PromotionalTierId": 1,
        "Percentage": 2,
        "Lives": 3,
        "PlanCount": 4
      },
      "Lives": 6,
      "PlanCount": 7
    },
    {
      "ProductId": 1,
      "MonthId": 3,
      "ControllerId": 4,
      "DrugListTier": {
        "DrugListTierId": 64,
        "Percentage": 2,
        "Lives": 3,
        "PlanCount": 4
      },
      "UnifiedTier": {
        "UnifiedTierId": 1,
        "Percentage": 2,
        "Lives": 3,
        "PlanCount": 4
      },
      "PromotionalTier": {
        "PromotionalTierId": 1,
        "Percentage": 2,
        "Lives": 3,
        "PlanCount": 4
      },
      "Lives": 6,
      "PlanCount": 7
    }
  ],
  "PlanCoverages": [
    {
      "PlanId": 1,
      "PlanTypeId": 64,
      "ChannelId": 3,
      "ProductId": 4,
      "MonthId": 5,
      "ControllerId": 6,
      "NoteId": 1,
      "NotesAvailable": 7,
      "Lives": 8,
      "DrugListTierId": 64,
      "FormularyTierId": 10,
      "FormularyUnifiedTierId": 11,
      "UnifiedTierId": 12,
      "PromotionalTierId": 1,
      "IsGeneric": true,
      "PriorAuthorization": true,
      "StepTherapy": true,
      "QuantityLimit": true,
      "SpecialtyPharmacy": true,
      "ConditionalPriorAuthorization": true,
      "DurableMedicalEquipment": true,
      "MedicalBenefit": true,
      "OverTheCounter": true,
      "Variance": true,
      "StateCarveOut": true,
      "FormularyId": 24
    },
    {
      "PlanId": 1,
      "PlanTypeId": 64,
      "ChannelId": 3,
      "ProductId": 4,
      "MonthId": 5,
      "ControllerId": 6,
      "NoteId": 1,
      "NotesAvailable": 7,
      "Lives": 8,
      "DrugListTierId": 64,
      "FormularyTierId": 10,
      "FormularyUnifiedTierId": 11,
      "UnifiedTierId": 12,
      "PromotionalTierId": 1,
      "IsGeneric": true,
      "PriorAuthorization": true,
      "StepTherapy": true,
      "QuantityLimit": true,
      "SpecialtyPharmacy": true,
      "ConditionalPriorAuthorization": true,
      "DurableMedicalEquipment": true,
      "MedicalBenefit": true,
      "OverTheCounter": true,
      "Variance": true,
      "StateCarveOut": true,
      "FormularyId": 24
    }
  ],
  "SummaryCoverages": [
    {
      "UnifiedTierId": 1,
      "Percentage": 2,
      "Lives": 3,
      "PlanCount": 4
    },
    {
      "UnifiedTierId": 1,
      "Percentage": 2,
      "Lives": 3,
      "PlanCount": 4
    }
  ],
  "Statement": "sample string 1"
}

<ControllerCoveragesResponse xmlns:i="http://www.w3.org/2001/XMLSchema-instance" xmlns="http://api.mmitnetwork.com/formulary/coverages">
  <ControllerCoverages>
    <Coverage>
      <ControllerId>4</ControllerId>
      <DrugListTier>
        <DrugListTierId>64</DrugListTierId>
        <Lives>3</Lives>
        <Percentage>2</Percentage>
        <PlanCount>4</PlanCount>
      </DrugListTier>
      <Lives>6</Lives>
      <MonthId>3</MonthId>
      <PlanCount>7</PlanCount>
      <ProductId>1</ProductId>
      <PromotionalTier>
        <Lives>3</Lives>
        <Percentage>2</Percentage>
        <PlanCount>4</PlanCount>
        <PromotionalTierId>1</PromotionalTierId>
      </PromotionalTier>
      <UnifiedTier>
        <Lives>3</Lives>
        <Percentage>2</Percentage>
        <PlanCount>4</PlanCount>
        <UnifiedTierId>1</UnifiedTierId>
      </UnifiedTier>
    </Coverage>
    <Coverage>
      <ControllerId>4</ControllerId>
      <DrugListTier>
        <DrugListTierId>64</DrugListTierId>
        <Lives>3</Lives>
        <Percentage>2</Percentage>
        <PlanCount>4</PlanCount>
      </DrugListTier>
      <Lives>6</Lives>
      <MonthId>3</MonthId>
      <PlanCount>7</PlanCount>
      <ProductId>1</ProductId>
      <PromotionalTier>
        <Lives>3</Lives>
        <Percentage>2</Percentage>
        <PlanCount>4</PlanCount>
        <PromotionalTierId>1</PromotionalTierId>
      </PromotionalTier>
      <UnifiedTier>
        <Lives>3</Lives>
        <Percentage>2</Percentage>
        <PlanCount>4</PlanCount>
        <UnifiedTierId>1</UnifiedTierId>
      </UnifiedTier>
    </Coverage>
  </ControllerCoverages>
  <PlanCoverages>
    <PlanCoverage>
      <ChannelId>3</ChannelId>
      <ConditionalPriorAuthorization>true</ConditionalPriorAuthorization>
      <ControllerId>6</ControllerId>
      <DrugListTierId>64</DrugListTierId>
      <DurableMedicalEquipment>true</DurableMedicalEquipment>
      <FormularyId>24</FormularyId>
      <FormularyTierId>10</FormularyTierId>
      <FormularyUnifiedTierId>11</FormularyUnifiedTierId>
      <IsGeneric>true</IsGeneric>
      <Lives>8</Lives>
      <MedicalBenefit>true</MedicalBenefit>
      <MonthId>5</MonthId>
      <NoteId>1</NoteId>
      <NotesAvailable>7</NotesAvailable>
      <OverTheCounter>true</OverTheCounter>
      <PlanId>1</PlanId>
      <PlanTypeId>64</PlanTypeId>
      <PriorAuthorization>true</PriorAuthorization>
      <ProductId>4</ProductId>
      <PromotionalTierId>1</PromotionalTierId>
      <QuantityLimit>true</QuantityLimit>
      <SpecialtyPharmacy>true</SpecialtyPharmacy>
      <StateCarveOut>true</StateCarveOut>
      <StepTherapy>true</StepTherapy>
      <UnifiedTierId>12</UnifiedTierId>
      <Variance>true</Variance>
    </PlanCoverage>
    <PlanCoverage>
      <ChannelId>3</ChannelId>
      <ConditionalPriorAuthorization>true</ConditionalPriorAuthorization>
      <ControllerId>6</ControllerId>
      <DrugListTierId>64</DrugListTierId>
      <DurableMedicalEquipment>true</DurableMedicalEquipment>
      <FormularyId>24</FormularyId>
      <FormularyTierId>10</FormularyTierId>
      <FormularyUnifiedTierId>11</FormularyUnifiedTierId>
      <IsGeneric>true</IsGeneric>
      <Lives>8</Lives>
      <MedicalBenefit>true</MedicalBenefit>
      <MonthId>5</MonthId>
      <NoteId>1</NoteId>
      <NotesAvailable>7</NotesAvailable>
      <OverTheCounter>true</OverTheCounter>
      <PlanId>1</PlanId>
      <PlanTypeId>64</PlanTypeId>
      <PriorAuthorization>true</PriorAuthorization>
      <ProductId>4</ProductId>
      <PromotionalTierId>1</PromotionalTierId>
      <QuantityLimit>true</QuantityLimit>
      <SpecialtyPharmacy>true</SpecialtyPharmacy>
      <StateCarveOut>true</StateCarveOut>
      <StepTherapy>true</StepTherapy>
      <UnifiedTierId>12</UnifiedTierId>
      <Variance>true</Variance>
    </PlanCoverage>
  </PlanCoverages>
  <Statement>sample string 1</Statement>
  <SummaryCoverages>
    <UnifiedTierCoverage>
      <Lives>3</Lives>
      <Percentage>2</Percentage>
      <PlanCount>4</PlanCount>
      <UnifiedTierId>1</UnifiedTierId>
    </UnifiedTierCoverage>
    <UnifiedTierCoverage>
      <Lives>3</Lives>
      <Percentage>2</Percentage>
      <PlanCount>4</PlanCount>
      <UnifiedTierId>1</UnifiedTierId>
    </UnifiedTierCoverage>
  </SummaryCoverages>
</ControllerCoveragesResponse>

Build Request


NameDescription Input Value Type Required / Optional
ProductId

The Id of the Product

integer

Required
BenefitDesignId

The Id of the BenefitDesign used as a Plan filter the response

integer

Optional
ChannelId

The Id of the Channel used as a Plan filter the response

Collection of integer

Optional
PlanTypeId

The Id of the PlanType used as a Plan filter the response

integer

Optional
StateId

The US State Id where the Plan(s) are covered

string

Optional
CBSAId

The CBSA(Service Area) Id where the Plan is covered

integer

Optional
TerritoryId

The Territory Id where the Plan is covered

integer

Optional
Options

Enter "PlanCoverages" to include Plan level coverage in addition to Controller coverage. Enter "SummaryCoverages" to include a summary of all statuses in addition to Controller coverage.

Collection of string

Optional
LivesTypeId

The Id to override the types of lives to shown (Default: 4)

integer

Optional
SummaryUseFormTrakControllerExclusions

Set to true to exclude FormTrak excluded controllers (Default: false)

boolean

Default value is False
StatusMapping

Please contact support for various options available

string

Optional
ApplyNLPolicies

Turns Coverage ON/OFF for NL and NTM policies. When 'PoliciesOn', the policies are applied and when 'PoliciesOff', the policies are turned off.

string

Optional




Request URL

GET Formulary/v1/Coverage?ProductId=ProductId&BenefitDesignId=BenefitDesignId&ChannelId=ChannelId&PlanTypeId=PlanTypeId&StateId=StateId&CBSAId=CBSAId&TerritoryId=TerritoryId&Options=Options&LivesTypeId=LivesTypeId&SummaryUseFormTrakControllerExclusions=SummaryUseFormTrakControllerExclusions&StatusMapping=StatusMapping&ApplyNLPolicies=ApplyNLPolicies

Status

Response Details