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
Request URL
GET Formulary/v1/Coverage/Plan
URI Parameters
| Name | Description | 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| Name | Description | 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
| Name | Description | 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
| Name | Description | 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| Name | Description | 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
| Name | Description | 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
| Name | Description | 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| Name | Description | 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
| Name | Description | 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
| Name | Description | 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| Name | Description | 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
| Name | Description | 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
| Name | Description | 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| Name | Description | 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
| Name | Description | 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
| Name | Description | 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| Name | Description | 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
| Name | Description | 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
| Name | Description | Type | Required / Optional |
|---|---|---|---|
| ProductId |
The Id of the Product |
integer |
Required |
| FormularyId |
The Id of the Formulary |
integer |
Optional |
| 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| Name | Description | 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
| Name | Description | Input Value | Type | Required / Optional |
|---|---|---|---|---|
| ProductId |
The Id of the Product |
integer |
Required |
|
| FormularyId |
The Id of the Formulary |
integer |
Optional |
|
| 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&FormularyId=FormularyId&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