Surescripts

Surescripts Eligibility and Formulary

Verifies patient pharmacy benefit eligibility and returns formulary and benefit coverage details so prescribers see coverage and coverage alternatives in workflow. Eligibility rides X12 270 request / 271 response exchange through the network; formulary rides the NCPDP Formulary and Benefit standard. Companion guides for both are published on the Surescripts Developer Portal; the machine-callable download surface is catalogued separately as the Formulary Download API.

Modeled, no public reference. Surescripts offers this API through a partner, certification or contract program and publishes no public reference for it. API Evangelist drew its shape from Surescripts's own material, so the endpoints on this page are a model, not the provider's contract.

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Documentation

📖
Documentation
https://docs.surescripts.com/eligibility/home
📖
APIReference
https://docs.surescripts.com/eligibility/guide
📖
Documentation
https://docs.surescripts.com/formulary/home

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API entry from apis.yml

apis.yml Raw ↑ 
aid: surescripts:surescripts-eligibility-formulary-api
name: Surescripts Eligibility and Formulary
tags:
- Eligibility
- Formulary
- Benefits
- X12
tags_raw:
- Eligibility
- Formulary
- Benefit
- X12
image: https://kinlane-images.s3.amazonaws.com/shared/apis-json/apis-json-logo.jpg
humanURL: https://docs.surescripts.com/eligibility/home
endpointsModeled: true
properties:
- url: https://docs.surescripts.com/eligibility/home
  type: Documentation
- url: https://docs.surescripts.com/eligibility/guide
  type: APIReference
- url: https://docs.surescripts.com/formulary/home
  type: Documentation
description: Verifies patient pharmacy benefit eligibility and returns formulary and benefit coverage
  details so prescribers see coverage and coverage alternatives in workflow. Eligibility rides X12 270
  request / 271 response exchange through the network; formulary rides the NCPDP Formulary and Benefit
  standard. Companion guides for both are published on the Surescripts Developer Portal; the machine-callable
  download surface is catalogued separately as the Formulary Download API.