Centers for Medicare and Medicaid Services Provider & Drug Coverage API
Lookup information on providers, drugs, and what is covered under what plans.
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OpenAPI Specification
openapi: 3.2.0
info:
title: Marketplace Provider & Drug Coverage API
version: '1'
description: '# About
The Marketplace API delivers data that helps users find and evaluate health care insurance plans, providers, and coverage information on the marketplace.'
servers:
- url: https://marketplace.api.healthcare.gov/api/v1
security:
- API Key: []
tags:
- name: Provider & Drug Coverage
description: Lookup information on providers, drugs, and what is covered under what plans.
paths:
/drugs/autocomplete:
x-summary: Drugs Autocomplete
get:
tags:
- Provider & Drug Coverage
description: Search prescription drugs
parameters:
- $ref: '#/components/parameters/apikey'
- $ref: '#/components/parameters/year-with-default'
- description: name of drug to search for (minimum 3 chars)
in: query
name: q
required: true
x-example: ibuprof
schema:
type: string
responses:
'200':
description: OK
content:
application/json:
schema:
properties:
drugs:
items:
$ref: '#/components/schemas/Drug'
type: array
type: object
summary: Autocomplete drugs by name
operationId: getDrugsAutocomplete
x-operation-id-source: derived
/drugs/search:
x-summary: Drugs Search
get:
tags:
- Provider & Drug Coverage
parameters:
- $ref: '#/components/parameters/apikey'
- $ref: '#/components/parameters/year-with-default'
- description: name of drug to search for
in: query
name: q
required: true
x-example: ibuprofen
schema:
type: string
responses:
'200':
description: OK
content:
application/json:
schema:
properties:
drugs:
items:
$ref: '#/components/schemas/Drug'
type: array
next:
description: URL of next page of results, if any
type: string
prev:
description: URL of previous page of results, if any
type: string
type: object
summary: Search prescription drugs
operationId: getDrugsSearch
x-operation-id-source: derived
/drugs/covered:
x-summary: Drug Coverage
get:
tags:
- Provider & Drug Coverage
summary: Get a list of whether drugs are covered by plans
parameters:
- $ref: '#/components/parameters/apikey'
- $ref: '#/components/parameters/year-with-default'
- description: array of drug RxCUIs
in: query
name: drugs
required: true
x-example: '1049589'
schema:
type: string
- description: array of plan IDs
in: query
name: planids
required: true
x-example: 11512NC0100031
schema:
type: string
responses:
'200':
description: OK
content:
application/json:
schema:
properties:
Provider & Drug Coverage:
items:
$ref: '#/components/schemas/DrugCoverage'
type: array
type: object
operationId: getDrugsCovered
x-operation-id-source: derived
/coverage/stats:
x-summary: Coverage Stats
get:
tags:
- Provider & Drug Coverage
parameters:
- $ref: '#/components/parameters/apikey'
description: Return statistics related to the number of coverage (drugs and providers) records.
responses:
'200':
description: OK
content:
application/json:
schema:
properties:
issuers:
type: integer
drugs:
type: integer
providers:
type: integer
providers_plans:
type: integer
drugs_plans:
type: integer
last_refreshed_at:
type: string
type: object
summary: Coverage statistics
operationId: getCoverageStats
x-operation-id-source: derived
/coverage/search:
x-summary: Coverage Search
get:
tags:
- Provider & Drug Coverage
parameters:
- $ref: '#/components/parameters/apikey'
- description: search query
in: query
name: q
required: true
x-example: hospital
schema:
type: string
- description: User's ZIP Code for searching nearby
in: query
name: zipcode
required: true
x-example: '19123'
schema:
type: string
responses:
'200':
description: OK
content:
application/json:
schema:
properties:
providers:
items:
$ref: '#/components/schemas/NearbyProvider'
type: array
drugs:
items:
$ref: '#/components/schemas/Drug'
type: array
type: object
required:
- providers
- drugs
summary: Search providers
operationId: getCoverageSearch
x-operation-id-source: derived
/providers/autocomplete:
x-summary: Provider Autocomplete
get:
tags:
- Provider & Drug Coverage
parameters:
- $ref: '#/components/parameters/apikey'
- description: search query (minimum 3 characters)
in: query
name: q
required: true
x-example: hospital
schema:
type: string
- description: 5-digit US zipcode
in: query
name: zipcode
required: true
x-example: '19123'
schema:
type: string
- description: Provider type, comma separated to specify multiple
in: query
required: true
name: type
x-example: Facility
schema:
type: string
enum:
- Individual
- Facility
- Group
responses:
'200':
description: OK
content:
application/json:
schema:
properties:
providers:
items:
$ref: '#/components/schemas/Provider'
type: array
summary: Autocomplete nearby providers
operationId: getProvidersAutocomplete
x-operation-id-source: derived
/providers/search:
x-summary: Provider Search
get:
tags:
- Provider & Drug Coverage
parameters:
- $ref: '#/components/parameters/apikey'
- $ref: '#/components/parameters/year-with-default'
- description: search query
in: query
name: q
required: true
x-example: hospital
schema:
type: string
- description: User's ZIP Code for searching nearby
in: query
name: zipcode
required: true
x-example: '19123'
schema:
type: string
- in: query
name: type
description: Provider type, comma separated to specify multiple
required: true
x-example: Facility
schema:
type: string
enum:
- Individual
- Facility
- in: query
name: specialty
required: false
schema:
type: string
responses:
'200':
description: OK
content:
application/json:
schema:
properties:
next:
description: URL of next page of results, if any
type: string
prev:
description: URL of previous page of results, if any
type: string
providers:
items:
$ref: '#/components/schemas/NearbyProvider'
type: array
type: object
required:
- providers
summary: Search providers
operationId: getProvidersSearch
x-operation-id-source: derived
/providers/covered:
x-summary: Provider Coverage
get:
tags:
- Provider & Drug Coverage
parameters:
- $ref: '#/components/parameters/apikey'
- description: array of provider NPIs
in: query
name: providerids
required: true
x-example: '1407884893'
schema:
type: string
- description: array of plan IDs
in: query
name: planids
required: true
x-example: 83761GA0040002
schema:
type: string
- $ref: '#/components/parameters/year-with-default'
responses:
'200':
description: OK
content:
application/json:
schema:
properties:
Provider & Drug Coverage:
items:
$ref: '#/components/schemas/ProviderCoverage'
type: array
type: object
summary: Get a list of whether a set of providers are covered by given plans
operationId: getProvidersCovered
x-operation-id-source: derived
components:
parameters:
year-with-default:
x-example: 2019
name: year
description: 4 digit market year (Defaults to the current year when not specified).
in: query
required: false
schema:
type: number
format: integer
apikey:
name: apikey
description: API key used for authentication
in: query
required: true
x-example: d687412e7b53146b2631dc01974ad0a4
schema:
type: string
schemas:
NPI:
type: string
pattern: ^[0-9]{10}$
properties: {}
ProviderGenderEnum:
enum:
- Male
- Female
- Other
- Transgender-female
- Transgender-male
- Non-binary
- Non-disclose
type: string
properties: {}
Provider:
properties:
name:
type: string
gender:
$ref: '#/components/schemas/ProviderGenderEnum'
specialties:
type: array
items:
type: string
type:
$ref: '#/components/schemas/ProviderTypeEnum'
accepting:
type: string
enum:
- accepting
- not accepting
- accepting in some locations
- unknown
npi:
type: string
pattern: ^[0-9]{10}$
title: National Provider Identifier
languages:
type: array
items:
type: string
facility_types:
type: array
items:
type: string
description: If provider is a facility, this is a list of the applicable facility types
taxonomy:
type: string
description: provider taxonomy from National Uniform Claim Committee
type: object
required:
- name
- type
- npi
DrugCoverage:
properties:
rxcui:
$ref: '#/components/schemas/RxCUI'
plan_id:
$ref: '#/components/schemas/PlanID'
coverage:
$ref: '#/components/schemas/Coverage'
generic_rxcui:
type: string
description: The RxCUI for the generic equivalent of the given drug
ProviderTypeEnum:
enum:
- Individual
- Facility
type: string
properties: {}
RxCUI:
type: string
pattern: ^[0-9]+$
properties: {}
PlanID:
type: string
pattern: ^[0-9]{5}[A-Z]{2}[0-9]{7}$
properties: {}
Address:
properties:
city:
type: string
state:
type: string
street_1:
type: string
street_2:
type: string
zipcode:
type: string
countyfips:
description: 5-digit county FIPS code
type: string
type: object
Drug:
properties:
id:
description: drug ID
type: string
pattern: ^[0-9]{1,10}$
name:
description: normalized SAB=RXNORM name
type: string
rxcui:
$ref: '#/components/schemas/RxCUI'
strength:
description: strength information for this drug
type: string
route:
description: route information for this drug
type: string
full_name:
description: full name information for this drug
type: string
rxterms_dose_form:
description: rxtermsDoseForm value for this drug
type: string
rxnorm_dose_form:
description: rxnormDoseForm for this drug
type: string
type: object
NearbyProvider:
properties:
provider:
$ref: '#/components/schemas/Provider'
address:
$ref: '#/components/schemas/Address'
distance:
type: number
minimum: 0
title: Distance in miles from address, eg., from a proximity search
type: object
required:
- provider
- distance
ProviderCoverage:
properties:
npi:
$ref: '#/components/schemas/NPI'
plan_id:
$ref: '#/components/schemas/PlanID'
coverage:
$ref: '#/components/schemas/Coverage'
addresses:
description: at which addresses this provider is covered by the plan, if any
type: array
items:
$ref: '#/components/schemas/Address'
accepting:
type: string
enum:
- accepting
- not accepting
- accepting in some locations
- unknown
Coverage:
type: string
enum:
- Covered
- NotCovered
- DataNotProvided
- GenericCovered
properties: {}
securitySchemes:
API_Key:
x-summary: API Key Auth
description: Your API key should be included as a query parameter with the request. You can [fill out this form](https://cms.gov1.qualtrics.com/jfe/form/SV_4N2GHCJfNuX7n8x) to request an API key.
type: apiKey
in: query
name: apikey
x-example: d687412e7b53146b2631dc01974ad0a4