UnitedHealth Group Drug Formulary API

openapi: 3.1.0
info:
  title: UnitedHealth Group Optum Clinical Data Drug Formulary API
  description: The UnitedHealth Group interoperability APIs provide FHIR R4-compliant access to healthcare data including patient records, claims history, provider directories, and formulary information in compliance with CMS Interoperability and Patient Access final rule (CMS-9115-F). Operates under the Optum platform serving UnitedHealthcare, UHC Medicare & Retirement, UHC Community & State, and Optum health services. Enables third-party applications and partners to access member health data using HL7 FHIR R4 standards for interoperable health data exchange.
  version: R4
  contact:
    name: UnitedHealth Group Interoperability
    url: https://www.uhc.com/legal/interoperability-apis
  license:
    name: UnitedHealth Group API Terms of Use
    url: https://www.uhc.com/legal/terms-of-use
servers:
- url: https://api.uhc.com/fhir/R4
  description: UnitedHealth Group FHIR R4 Production
security:
- bearerAuth: []
tags:
- name: Drug Formulary
  description: FHIR R4 Drug Formulary API for prescription drug coverage information
paths:
  /MedicationKnowledge:
    get:
      operationId: listFormularyDrugs
      summary: UnitedHealth Group List Formulary Drug Coverage
      description: Retrieve drug formulary information from the UnitedHealthcare FHIR R4 Drug Formulary API including coverage tiers, formulary status, prior authorization requirements, quantity limits, and step therapy requirements for prescription drugs. Implements the Da Vinci Drug Formulary IG.
      tags:
      - Drug Formulary
      x-microcks-operation:
        dispatcher: SCRIPT
        dispatcherRules: return 'DEFAULT';
      parameters:
      - name: code
        in: query
        required: false
        description: RxNorm drug code
        schema:
          type: string
      - name: drug-name
        in: query
        required: false
        description: Drug name search string
        schema:
          type: string
      - name: tier
        in: query
        required: false
        description: Formulary tier number filter
        schema:
          type: string
      - name: _count
        in: query
        required: false
        description: Maximum number of results
        schema:
          type: integer
          default: 20
      responses:
        '200':
          description: FHIR Bundle of MedicationKnowledge resources
          content:
            application/fhir+json:
              schema:
                $ref: '#/components/schemas/FHIRBundle'
        '401':
          description: Unauthorized
        '429':
          description: Too many requests
components:
  schemas:
    FHIRBundle:
      type: object
      description: FHIR R4 Bundle resource containing a collection of FHIR resources returned from UnitedHealth Group interoperability API search operations
      properties:
        resourceType:
          type: string
          enum:
          - Bundle
          description: FHIR resource type identifier
        id:
          type: string
          description: Unique Bundle ID
        meta:
          type: object
          description: Bundle metadata
          properties:
            lastUpdated:
              type: string
              format: date-time
        type:
          type: string
          enum:
          - searchset
          - collection
          description: Bundle type
        total:
          type: integer
          description: Total number of matching resources
        link:
          type: array
          description: Pagination and navigation links
          items:
            type: object
            properties:
              relation:
                type: string
                enum:
                - self
                - next
                - previous
                - first
                - last
              url:
                type: string
                format: uri
        entry:
          type: array
          description: Bundle entries containing FHIR resources
          items:
            type: object
            properties:
              fullUrl:
                type: string
                format: uri
              resource:
                type: object
                description: The embedded FHIR resource
              search:
                type: object
                properties:
                  mode:
                    type: string
                    enum:
                    - match
                    - include
                    - outcome
  securitySchemes:
    bearerAuth:
      type: http
      scheme: bearer
      description: OAuth 2.0 Bearer token obtained via authorization code flow
externalDocs:
  description: UnitedHealth Group Interoperability APIs
  url: https://www.uhc.com/legal/interoperability-apis