Interoperability Provider Directory API - Formulary

Product Overview

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

Product Description

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

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

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

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

APIs in this category follow the DaVinci Payer Data Exchange US Drug Formulary Implementation Guide v1.0.1 found at

Getting Started

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

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

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

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


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

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

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

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

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

This release contains concepts created by the National Library of Medicine which express the meaning of a drug name in a normalized form. These concepts relate the names of orderable medications to a dose form and the components of those medications. For further discussion, see the article at:

Contact: RxNorm Customer Service; U.S. National Library of Medicine; 8600 Rockville Pike; Bethesda, MD, United States 20894; (888) FIND-NLM; [email protected];

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

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

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

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


Click here to learn about Sandbox Availability.

Payer IDs

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

Payer NamePayer ID (Sandbox Use)Payer ID (Production)
Agewell New York659602387A50487F9D0099BF628C036EA83FE8926A784807AED2EE698D7D41C8
Alliant Health Plan0A2FBCCBCD1341758CBD3D19CA38B67769553C6F4A7D498C87C86E2FA72162EA
American Health PlanB8A939145662499DB596B28E4C52013B6F6E685928A9489EBF16F379CB4ACD22
Apex Health12AFCA132E24429FB1C1C19013406017A6C60D0D65444EFE8DED268BBC91CB81
Aspire Health1C7758BDDEE041CA9E05B191F76DC4D8454E77479DA74A4489C27F3B5614DF6B
Aspirus HealthF4CF82752C544E108FE64A1B768A75297FD6224C2EC140B7A5C98987CAA984B0
BayCare Health Plans089E6BC649154164BF35A9F75D731862A665620511BE49B0BB5AE9663E2FAEFB
Health Team Advantage8FE3FDF60C1A4FA09C6FB2D38D27BB0835CA33CD8947488BA18A605D0B506AD5
Christus Health Plan3FA7DF8754AC4C6A87576F506B15C6FDA5F4CD753970481E875D0C5C09B78CC3
Clear Spring Health895CF21043C84A619470CACF72D7DB202EBEDCFEC6DF4DD38C154463E48530F3
Common Ground HealthcareA40F1A3474AA4F0AA1E43B185845F47C174690E0EDC94052800823F72927EA9A
Community Care Inc.10764EE705B24D96ABF58A1E78FA75926E4E36FB80464838905AA540C774E676
Cox Health PlanD697A4D7543C4700A70C5A55EFE01DD39B47D1AE0461464AA12C8B418D023112
Doctors Healthcare Plans6406440EB69D468DA4214E9C541E4A0D6178ABF0FFD3488FAB4EB7FAFB39C6F0
Driscoll Children's Health Plan53BCD52D2D664E2CA5A475E40A22AE8732487A105D064243A0E76E1904F89E23
El Paso Health8CD1A590350B47E69BF44247AF189DCBA248E96D53254728A2BA159AA3F99D70
Essence Healthcare Advantage Plans40411026C2AA4C7E8A16BA649233DD73EFD807C6404942F3BCCAB8E9D1BE030A
Freedom Health PlanFF4BE0D6D861444AA8B3C6797D1DE3C7EA3E20C2ADCB44CF81D9882C7D83CBFD
Friday Health PlanC67ECC0DFDBF49B8A674F35C84B2F8F1C48DBB1592DC4125BC0A08600ED1F2D6
Gateway Health Plan28853FF7DD1B4DD1BC4680E62EBBAE62C16CB396782849198C7E17606E0EFE67
Global Health8E661FD116044898B4232A44BAE5AE23E77AB398A16F46CD91B8FC10D593AD2B
Golden State Medicare Health PlanEE8F066F7DF94B6DBD6823F8D606AAE5217CC2BF778A4AB0B74AB37EE2957922
Health First Health Plan75C106CD845D467DB78AE7C060C5A5BB88F6F4C98E4B427484F0E9EFFC19F60D
Health Sun5E1E6D6EA57440B6A30093614520A98D5AA8E68CC2ED4E30B18B6DC198534FA2
Hometown Health PlanD917EFECF68A4ED6B06135FF41C3EF05E001CF16A36E4246B02363ACA717FD4A
Independent Living Systems7616A5EC4B344DEBA0B2A24DDC57B45F274D24650F564E41A820EA52809FDAD4
Indiana University Health Plans2B25CFE52F3B11EB83A6124E422C9EF1F8124FB4CA864400983DDA6C27B7F35E
Integra Managed CareDC067EAE52134A9CBB7C70BB2BE740524E27C3AD1C0B42BD8BE3C613D8D428E0
Johns Hopkins -AdvantageMD6918AA98A6654AC2A14C73EE7CF11AC3AC29F5DAC03E4135A5A9A48D99229435
LA Care9C51A8B521634DD8B0E2F3A8C192251FF808CEFEB14044E4A16A0F5B63AC0BCD
Leon Health6D7701B507774E58B36E1C70067F6553BB8F788099784CE393AD79C02647747A
Mary Washington Health PlansECA9417B2B8E4E61AB9C125B9CA45AD568AD95D5FA6940DEB54B0DDA71C7297E
My Choice Wisconsin4A13EAC43F4442D5A70FBF11C1207CA8908E30FEB98848BD854DEA6DF3A68399
Nascentia Health Inc416DB822AA974709B52C79E6DC8F168588B47DA170E54C778D3DD34014ED80E2
Network Health Plan443224A36B2845D28B7AA818ECC6198CTBD
Optimum Healthcare910FF74C3B22431098D672DB25FC61B0E645709AE4B0469F82273E8030617ECD
Physicians Health Plan Medicare07AE89BA7CA144B1949061F45E978ACC8AC6CF8123404F0EAF126FD6ABEA22A8
Priority Partners6918AA98A6654AC2A14C73EE7CF11AC3AC29F5DAC03E4135A5A9A48D99229435
RAM Technologies204644834C054166988267AF2EB5FA465F2DA3C7FA944F70A7157F319B0DF502
Sendero Health Plan5EA2BAF3CF7045159514C7E91C24B52858E62055568B485A947D77EB321ACC41
Simpra Advantage77943435E5B7481086D3C683A8363D91C0F24AA649EC4850B898A70EFD1811A8
Stanford Healthcare Advantage Plan64A437F22BBA4037B8DB8D46852136E47BDF3145E2E94A33AC24A5CB62A0575D
Texas Children's Health PlanF64158E7883E4950BB2314A6A52EC54F6DCAB8371F5F4B31A480EB445817F72C
The Health Plan of West VirginiaD9062EE4542E40319AEFBDBE660DF7E4FC7DDBF9905841DEB0A4552534744117
Viva Health62DCE6B01F8011EB83A6124E422C9EF1FE1BB605C6BF41C581EC0B80A3A8D5E9
Vivida Health68AC266D08A7441FB52C72E76114B2070578E5A63F23496F9C094644066DBC0C
Yamhill Community Care Organization YCCOF8D39E90073F4E0B90B87E697C2B7C66E6C9787E21844243B00B6B17647F3881
Change Log
View our Change Log/Release Notes for more information on this API