Public FHIR R4 read API exposing the Clover Health drug formulary (covered medications, tiers, utilization management) and provider directory (practitioners, organizations, locations, healthcare services, and insurance plans). 22 read operations across two services.
openapi: 3.0.3
info:
title: FHIR API
version: 1.0.0
description: Formulary and Provider Directory API
paths:
/formulary/api/List:
get:
operationId: list_formulary
description: This interaction searches a set of resources based on some filter
criteria.
summary: This interaction searches a set of resources based on some filter criteria.
parameters:
- in: query
name: _count
schema:
type: integer
maximum: 10000
minimum: 1
default: 20
title: ' count'
description: Maximum number of results to be returned
- in: query
name: _offset
schema:
type: integer
minimum: 0
default: 0
title: ' offset'
description: Number of results to be offset
- in: query
name: _profile
schema:
type: string
title: ' profile'
minLength: 1
description: An URL of profile in structured definition
- in: query
name: identifier
schema:
type: string
minLength: 1
description: CoveragePlan identifier. It can be in the type of CloverHealth's
identifier (E.g. 001, 002) or the plan ID (E.g. H5141)
- in: query
name: item
schema:
type: string
minLength: 1
description: The identifier of the associated FormularyDrug (also known as
MedicationKnowledge) under the CoveragePlan
- in: query
name: status
schema:
enum:
- current
- retired
- entered-in-error
type: string
minLength: 1
description: |-
* `current` - current
* `retired` - retired
* `entered-in-error` - entered-in-error
tags:
- fhir-r4-formulary-api
security:
- cookieAuth: []
- basicAuth: []
- {}
responses:
'200':
content:
application/fhir+json:
schema:
$ref: '#/components/schemas/FormularyListResponse'
examples:
JSONExample:
value:
resourceType: Bundle
id: 14f5b0a7-2d8b-43fb-a46e-b6c7d92aa59e
meta:
lastUpdated: '2021-05-27T03:30:14.877Z'
type: searchset
total: 1
link:
- relation: self
url: https://public-api.cloverhealth.com/formulary/api/List
entry:
- fullUrl: https://public-api.cloverhealth.com/formulary/api/List/a1bf521c-7fe0-5329-b1bb-8858a52cd807
search:
mode: match
resource:
resourceType: List
id: a1bf521c-7fe0-5329-b1bb-8858a52cd807
meta:
lastUpdated: '2021-05-18T10:18:01.162981+00:00'
profile:
- http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-CoveragePlan
identifier:
- system: https://www.cloverhealth.com/plans
value: '001'
- system: https://www.cloverhealth.com/plans
value: '002'
- value: H5141
status: current
mode: snapshot
title: H5141
date: '2021-05-18T10:18:01.162981+00:00'
extension:
- url: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-DrugTierDefinition-extension
extension:
- url: drugTierID
valueCodeableConcept:
coding:
- system: http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-DrugTierCS
code: preferred-brand
display: 'Preferred Brand: Brand name drugs'
- url: mailOrder
valueBoolean: true
- url: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-DrugTierDefinition-extension
extension:
- url: drugTierID
valueCodeableConcept:
coding:
- system: http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-DrugTierCS
code: specialty
display: 'Specialty: Drugs used to treat complex conditions
like cancer and multiple sclerosis.They can be generic
or brand name, and are typically the most expensive
drugs on the formulary.'
- url: mailOrder
valueBoolean: true
- url: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-DrugTierDefinition-extension
extension:
- url: drugTierID
valueCodeableConcept:
coding:
- system: http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-DrugTierCS
code: non-preferred-generic
display: 'Non-preferred Generic: Generic drugs that
cost more than drugs in ‘generic’ tier.'
- url: mailOrder
valueBoolean: true
- url: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-DrugTierDefinition-extension
extension:
- url: drugTierID
valueCodeableConcept:
coding:
- system: http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-DrugTierCS
code: generic
display: 'Generic: Commonly prescribed generic drugs
that cost more than drugs in the ‘preferred generic’
tier.'
- url: mailOrder
valueBoolean: true
- url: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-DrugTierDefinition-extension
extension:
- url: drugTierID
valueCodeableConcept:
coding:
- system: http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-DrugTierCS
code: non-preferred-brand
display: 'Non-preferred Brand: Brand name drugs that
cost more than ‘brand’ drugs.'
- url: mailOrder
valueBoolean: true
- url: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-Network-extension
valueString: Not Applicable
- url: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-SummaryURL-extension
valueString: https://cdn.cloverhealth.com/filer_public/d0/b6/d0b6294a-2e6b-4504-b9d4-bf65a4753210/76207_nj_eng_ch_nj_cy21_5t_gs_core_april_21.pdf
- url: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-PlanIDType-extension
valueString: HIOS-PLAN-ID
entry:
- item:
reference: MedicationKnowledge/000212621243033
- item:
reference: MedicationKnowledge/000212621923056
summary: JSON Example
description: |2
ListBundle
Contains a collection of resources
- Rule: total only when a search or history
- Rule: entry.search only when a search
- Rule: entry.request mandatory for batch/transaction/history, otherwise prohibited
- Rule: entry.response mandatory for batch-response/transaction-response/history, otherwise prohibited
- Rule: FullUrl must be unique in a bundle, or else entries with the same fullUrl must have different meta.versionId (except in history bundles)
- Rule: A document must have an identifier with a system and a value
- Rule: A document must have a date
- Rule: A document must have a Composition as the first resource
- Rule: A message must have a MessageHeader as the first resource Elements defined in Ancestors: id, meta, implicitRules, language
application/fhir+xml:
schema:
$ref: '#/components/schemas/FormularyListResponse'
examples:
XMLExample:
value: |2
<?xml version='1.0' encoding='UTF-8'?>
<Bundle xmlns="http://hl7.org/fhir">
<id value="901d94d9-cbcf-4e11-abc9-4c7b88370987"/>
<meta>
<lastUpdated value="2021-05-27T03:29:00.024Z"/>
</meta>
<type value="searchset"/>
<total value="1"/>
<link>
<relation value="self"/>
<url value="https://public-api.cloverhealth.com/formulary/api/List"/>
</link>
<entry>
<fullUrl value="https://public-api.cloverhealth.com/formulary/api/List/a1bf521c-7fe0-5329-b1bb-8858a52cd807"/>
<resource>
<List xmlns="http://hl7.org/fhir">
<id value="a1bf521c-7fe0-5329-b1bb-8858a52cd807"/>
<meta>
<lastUpdated value="2021-05-18T10:18:01.162981+00:00"/>
<profile value="http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-CoveragePlan"/>
</meta>
<extension url="http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-DrugTierDefinition-extension">
<extension url="drugTierID">
<valueCodeableConcept>
<coding>
<system value="http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-DrugTierCS"/>
<code value="preferred-brand"/>
<display value="Preferred Brand: Brand name drugs"/>
</coding>
</valueCodeableConcept>
</extension>
<extension url="mailOrder">
<valueBoolean value="true"/>
</extension>
</extension>
<extension url="http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-DrugTierDefinition-extension">
<extension url="drugTierID">
<valueCodeableConcept>
<coding>
<system value="http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-DrugTierCS"/>
<code value="specialty"/>
<display value="Specialty: Drugs used to treat complex conditions like cancer and multiple sclerosis.They can be generic or brand name, and are typically the most expensive drugs on the formulary."/>
</coding>
</valueCodeableConcept>
</extension>
<extension url="mailOrder">
<valueBoolean value="true"/>
</extension>
</extension>
<extension url="http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-DrugTierDefinition-extension">
<extension url="drugTierID">
<valueCodeableConcept>
<coding>
<system value="http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-DrugTierCS"/>
<code value="non-preferred-generic"/>
<display value="Non-preferred Generic: Generic drugs that cost more than drugs in ‘generic’ tier."/>
</coding>
</valueCodeableConcept>
</extension>
<extension url="mailOrder">
<valueBoolean value="true"/>
</extension>
</extension>
<extension url="http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-DrugTierDefinition-extension">
<extension url="drugTierID">
<valueCodeableConcept>
<coding>
<system value="http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-DrugTierCS"/>
<code value="generic"/>
<display value="Generic: Commonly prescribed generic drugs that cost more than drugs in the ‘preferred generic’ tier."/>
</coding>
</valueCodeableConcept>
</extension>
<extension url="mailOrder">
<valueBoolean value="true"/>
</extension>
</extension>
<extension url="http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-DrugTierDefinition-extension">
<extension url="drugTierID">
<valueCodeableConcept>
<coding>
<system value="http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-DrugTierCS"/>
<code value="non-preferred-brand"/>
<display value="Non-preferred Brand: Brand name drugs that cost more than ‘brand’ drugs."/>
</coding>
</valueCodeableConcept>
</extension>
<extension url="mailOrder">
<valueBoolean value="true"/>
</extension>
</extension>
<extension url="http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-Network-extension">
<valueString value="Not Applicable"/>
</extension>
<extension url="http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-SummaryURL-extension">
<valueString value="https://cdn.cloverhealth.com/filer_public/d0/b6/d0b6294a-2e6b-4504-b9d4-bf65a4753210/76207_nj_eng_ch_nj_cy21_5t_gs_core_april_21.pdf"/>
</extension>
<extension url="http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-PlanIDType-extension">
<valueString value="HIOS-PLAN-ID"/>
</extension>
<identifier>
<system value="https://www.cloverhealth.com/plans"/>
<value value="001"/>
</identifier>
<identifier>
<system value="https://www.cloverhealth.com/plans"/>
<value value="002"/>
</identifier>
<identifier>
<value value="H5141"/>
</identifier>
<status value="current"/>
<mode value="snapshot"/>
<title value="H5141"/>
<date value="2021-05-18T10:18:01.162981+00:00"/>
<entry>
<item>
<reference value="MedicationKnowledge/000212621243033"/>
</item>
</entry>
<entry>
<item>
<reference value="MedicationKnowledge/000212621923056"/>
</item>
</entry>
</List>
</resource>
<search>
<mode value="match"/>
</search>
</entry>
</Bundle>
summary: XML Example
description: |2
ListBundle
Contains a collection of resources
- Rule: total only when a search or history
- Rule: entry.search only when a search
- Rule: entry.request mandatory for batch/transaction/history, otherwise prohibited
- Rule: entry.response mandatory for batch-response/transaction-response/history, otherwise prohibited
- Rule: FullUrl must be unique in a bundle, or else entries with the same fullUrl must have different meta.versionId (except in history bundles)
- Rule: A document must have an identifier with a system and a value
- Rule: A document must have a date
- Rule: A document must have a Composition as the first resource
- Rule: A message must have a MessageHeader as the first resource Elements defined in Ancestors: id, meta, implicitRules, language
description: ''
/formulary/api/List/{id}:
get:
operationId: list_formulary_item
description: The read interaction accesses the current contents of a resource.
summary: The read interaction accesses the current contents of a resource.
parameters:
- in: path
name: id
schema:
type: string
required: true
tags:
- fhir-r4-formulary-api
security:
- cookieAuth: []
- basicAuth: []
- {}
responses:
'200':
content:
application/fhir+json:
schema:
$ref: '#/components/schemas/FormularyListItemResponse'
examples:
JSONExample:
value:
resourceType: List
id: a1bf521c-7fe0-5329-b1bb-8858a52cd807
meta:
lastUpdated: '2021-05-18T10:18:01.162981+00:00'
profile:
- http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-CoveragePlan
identifier:
- system: https://www.cloverhealth.com/plans
value: '001'
- system: https://www.cloverhealth.com/plans
value: '002'
- value: H5141
status: current
mode: snapshot
title: H5141
date: '2021-05-18T10:18:01.162981+00:00'
extension:
- url: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-DrugTierDefinition-extension
extension:
- url: drugTierID
valueCodeableConcept:
coding:
- system: http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-DrugTierCS
code: preferred-generic
display: 'Preferred Generic: Commonly prescribed generic
drugs.'
- url: mailOrder
valueBoolean: true
- url: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-DrugTierDefinition-extension
extension:
- url: drugTierID
valueCodeableConcept:
coding:
- system: http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-DrugTierCS
code: non-preferred-generic
display: 'Non-preferred Generic: Generic drugs that cost
more than drugs in ‘generic’ tier.'
- url: mailOrder
valueBoolean: true
- url: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-DrugTierDefinition-extension
extension:
- url: drugTierID
valueCodeableConcept:
coding:
- system: http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-DrugTierCS
code: non-preferred-brand
display: 'Non-preferred Brand: Brand name drugs that cost
more than ‘brand’ drugs.'
- url: mailOrder
valueBoolean: true
- url: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-Network-extension
valueString: Not Applicable
- url: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-SummaryURL-extension
valueString: https://cdn.cloverhealth.com/filer_public/d0/b6/d0b6294a-2e6b-4504-b9d4-bf65a4753210/76207_nj_eng_ch_nj_cy21_5t_gs_core_april_21.pdf
- url: http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-PlanIDType-extension
valueString: HIOS-PLAN-ID
entry:
- item:
reference: MedicationKnowledge/000212621000001
- item:
reference: MedicationKnowledge/000212621000048
summary: JSON Example
description: |2
List
A list is a curated collection of resources
- Rule: A list can only have an emptyReason if it is empty
- Rule: The deleted flag can only be used if the mode of the list is "changes"
- Rule: An entry date can only be used if the mode of the list is "working" Elements defined in Ancestors: id, meta, implicitRules, language, text, contained, extension, modifierExtension
application/fhir+xml:
schema:
$ref: '#/components/schemas/FormularyListItemResponse'
examples:
XMLExample:
value: |-
<?xml version='1.0' encoding='UTF-8'?>
<List xmlns="http://hl7.org/fhir">
<id value="a1bf521c-7fe0-5329-b1bb-8858a52cd807"/>
<meta>
<lastUpdated value="2021-05-18T10:18:01.162981+00:00"/>
<profile value="http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-CoveragePlan"/>
</meta>
<extension url="http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-DrugTierDefinition-extension">
<extension url="drugTierID">
<valueCodeableConcept>
<coding>
<system value="http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-DrugTierCS"/>
<code value="preferred-generic"/>
<display value="Preferred Generic: Commonly prescribed generic drugs."/>
</coding>
</valueCodeableConcept>
</extension>
<extension url="mailOrder">
<valueBoolean value="true"/>
</extension>
</extension>
<extension url="http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-DrugTierDefinition-extension">
<extension url="drugTierID">
<valueCodeableConcept>
<coding>
<system value="http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-DrugTierCS"/>
<code value="non-preferred-generic"/>
<display value="Non-preferred Generic: Generic drugs that cost more than drugs in ‘generic’ tier."/>
</coding>
</valueCodeableConcept>
</extension>
<extension url="mailOrder">
<valueBoolean value="true"/>
</extension>
</extension>
<extension url="http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-DrugTierDefinition-extension">
<extension url="drugTierID">
<valueCodeableConcept>
<coding>
<system value="http://hl7.org/fhir/us/davinci-drug-formulary/CodeSystem/usdf-DrugTierCS"/>
<code value="non-preferred-brand"/>
<display value="Non-preferred Brand: Brand name drugs that cost more than ‘brand’ drugs."/>
</coding>
</valueCodeableConcept>
</extension>
<extension url="mailOrder">
<valueBoolean value="true"/>
</extension>
</extension>
<extension url="http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-Network-extension">
<valueString value="Not Applicable"/>
</extension>
<extension url="http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-SummaryURL-extension">
<valueString value="https://cdn.cloverhealth.com/filer_public/d0/b6/d0b6294a-2e6b-4504-b9d4-bf65a4753210/76207_nj_eng_ch_nj_cy21_5t_gs_core_april_21.pdf"/>
</extension>
<extension url="http://hl7.org/fhir/us/davinci-drug-formulary/StructureDefinition/usdf-PlanIDType-extension">
<valueString value="HIOS-PLAN-ID"/>
</extension>
<identifier>
<system value="https://www.cloverhealth.com/plans"/>
<value value="001"/>
</identifier>
<identifier>
<system value="https://www.cloverhealth.com/plans"/>
<value value="002"/>
</identifier>
<identifier>
<value value="H5141"/>
</identifier>
<status value="current"/>
<mode value="snapshot"/>
<title value="H5141"/>
<date value="2021-05-18T10:18:01.162981+00:00"/>
<entry>
<item>
<reference value="MedicationKnowledge/000212621000001"/>
</item>
</entry>
<entry>
<item>
<reference value="MedicationKnowledge/000212621000048"/>
</item>
</entry>
</List>
summary: XML Example
description: |2
List
A list is a curated collection of resources
- Rule: A list can only have an emptyReason if it is empty
- Rule: The deleted flag can only be used if the mode of the list is "changes"
- Rule: An entry date can only be used if the mode of the list is "working" Elements defined in Ancestors: id, meta, implicitRules, language, text, contained, extension, modifierExtension
description: ''
/formulary/api/MedicationKnowledge:
get:
operationId: search_medication_knowledge
description: This interaction searches a set of resources based on some filter
criteria.
summary: This interaction searches a set of resources based on some filter criteria.
parameters:
- in: query
name: DrugName
schema:
type: string
minLength: 1
description: Name of the drug
- in: query
name: DrugPlan
schema:
type: string
minLength: 1
description: Plan of the drug
- in: query
name: DrugTier
schema:
type: string
minLength: 1
description: Drug tier of the drug
- in: query
name: _count
schema:
type: integer
maximum: 10000
minimum: 1
default: 20
title: ' count'
description: Maximum number of results to be returned
- in: query
name: _offset
schema:
type: integer
minimum: 0
default: 0
title: ' offset'
description: Number of results to be offset
- in: query
name: _profile
schema:
type: string
title: ' profile'
minLength: 1
description: An URL of profile in structured definition
- in: query
name: code
schema:
type: string
minLength: 1
description: Rx code of the drug
tags:
- fhir-r4-formulary-api
security:
- cookieAuth: []
- basicAuth: []
- {}
responses:
'200':
content:
application/fhir+json:
schema:
$ref: '#/components/schemas/FormularyMedicationKnowledgeResponse'
examples:
JSONExample:
value:
resourceType: Bundle
id: 2f6e91d0-60ea-41b6-96cb-354ec38697ad
meta:
lastUpdated: '2021-05-27T12:10:37.416+08:00'
type: searchset
total: 2
link:
- relation: self
url: https://public-api.cloverhealth.com/formulary/api/MedicationKnowledge
entry:
- fullUrl: https://public-api.cloverhealth.com/formulary/api/MedicationKnowledge/000211871000001
resource:
resourceType: MedicationKnowledge
id: 000211871000001
meta:
profile:
- http://hl7.org/fhir/us/davinc
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