Interoperability Provider Directory API Formulary v1

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Overview

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

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

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

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

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