Truepill Insurance API

openapi: 3.0.1
info:
  title: Truepill (FuzeRx) Insurance API
  description: REST API for Truepill's pharmacy and healthcare-infrastructure platform, now shipping as FuzeRx after LetsGetChecked's 2024 acquisition of Truepill and the May 2025 rebrand to Fuze Health. The API exposes JSON over HTTPS for patient management, prescriptions, pharmacy-to-pharmacy transfers, insurance and copay adjudication, and webhook event retrieval. Endpoints and field names below reflect Truepill/FuzeRx public developer documentation; request and response bodies are summarized and should be reconciled against the live reference at https://rxdocs.fuzehealth.com before production use.
  termsOfService: https://www.truepill.com/terms-of-service
  contact:
    name: FuzeRx Support
    email: rx.support@fuzehealth.com
  version: v1
servers:
- url: https://rxapi.fuzehealth.com/v1
  description: Production
- url: https://rxapi.sandbox.fuzehealth.com/v1
  description: Sandbox
security:
- ApiKeyAuth: []
tags:
- name: Insurance
  description: Insurance objects, copay requests, and claim adjudication.
paths:
  /insurance:
    post:
      operationId: createInsurance
      tags:
      - Insurance
      summary: Create an insurance object for a patient.
      description: Establishes a patient's pharmacy benefit details (BIN, PCN, group number, member ID) for use in copay determination and claim adjudication.
      requestBody:
        required: true
        content:
          application/json:
            schema:
              $ref: '#/components/schemas/Insurance'
      responses:
        '200':
          description: Insurance object created.
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/Insurance'
  /copay_request:
    post:
      operationId: createCopayRequest
      tags:
      - Insurance
      summary: Create a copay request.
      description: Submits patient insurance and prescription details to determine a patient's real-time out-of-pocket expense for a medication. Results may also be delivered asynchronously via webhook events.
      requestBody:
        required: true
        content:
          application/json:
            schema:
              $ref: '#/components/schemas/CopayRequest'
      responses:
        '200':
          description: Copay request accepted.
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/CopayResponse'
  /insurance_claim:
    get:
      operationId: getInsuranceClaim
      tags:
      - Insurance
      summary: Get insurance claim details.
      description: Queries claim details from successfully adjudicated insurance claims. Access to this endpoint is restricted.
      responses:
        '200':
          description: Insurance claim details.
          content:
            application/json:
              schema:
                $ref: '#/components/schemas/InsuranceClaim'
components:
  schemas:
    Insurance:
      type: object
      properties:
        patient_token:
          type: string
        bin:
          type: string
        pcn:
          type: string
        group_number:
          type: string
        member_id:
          type: string
        relationship_code:
          type: string
        priority:
          type: string
          description: primary, secondary, or tertiary.
    CopayResponse:
      type: object
      properties:
        copay_request_token:
          type: string
        status:
          type: string
        copay_amount:
          type: number
        currency:
          type: string
        timestamp:
          type: string
          format: date-time
    InsuranceClaim:
      type: object
      properties:
        claim_id:
          type: string
        prescription_token:
          type: string
        bin:
          type: string
        adjudicated_amount:
          type: number
        patient_pay_amount:
          type: number
        status:
          type: string
    CopayRequest:
      type: object
      properties:
        patient_token:
          type: string
        prescription_token:
          type: string
        ndc:
          type: string
        quantity:
          type: number
        days_supply:
          type: integer
  securitySchemes:
    ApiKeyAuth:
      type: apiKey
      in: header
      name: Authorization
      description: 'API key passed as `Authorization: ApiKey <YOUR_API_KEY>`. Separate keys are issued for the sandbox and production environments.'