Amerihealth Caritas Plans Pricing
AmeriHealth Caritas exposes HL7 FHIR R4 APIs (Patient Access, Provider Directory, Drug Formulary) to satisfy the CMS Interoperability and Patient Access final rule (CMS-9115-F). The APIs are free to registered third-party applications: access is governed by SMART on FHIR / OAuth 2.0, member consent, and a CMS-aligned attestation rather than a commercial price tier. There is no list price, no metered rate card, and no paid subscription. Member health-plan products (Medicaid, CHIP, D-SNP, LTSS, Marketplace) are sold through state Medicaid agencies, CMS, and state Marketplaces and are out of scope for an API pricing surface.
Amerihealth Caritas Plans Pricing is the machine-readable pricing-plan profile for AmeriHealth Caritas on the APIs.io network, conforming to the API Commons Plans specification.
It defines 4 plans, covering freemium tiers, with named plans including Developer Sandbox, CMS Patient Access (Production), Provider Directory (Public), Drug Formulary (Public).
Tagged areas include FHIR, Healthcare, Health Insurance, Medicaid, and Interoperability.
Plans
Free sandbox access for testing against synthetic patient data, the live FHIR CapabilityStatements, and the per-plan FHIR endpoints. Sandbox member credentials are issued to registered developers after account activation.
- FHIR R4 sandbox endpoints (Patient Access & Provider Directory)
- Synthetic patient credentials issued to registered developers
- Live CapabilityStatements per plan code
- SMART App Launch / OAuth 2.0 / PKCE test flows
- No commercial cost
Production access for third-party member-facing apps under CMS- 9115-F. Requires developer registration, app attestation, and SMART on FHIR / OAuth 2.0 with member consent. No fees are charged to the application or member.
- SMART on FHIR / OAuth 2.0 + PKCE member consent
- Per-plan FHIR endpoint routing (0100, 0500, 0900, 2400, 2600)
- AllergyIntolerance, Claim, Condition, Coverage, Encounter, ExplanationOfBenefit
- Immunization, Medication, MedicationDispense, MedicationKnowledge, MedicationRequest
- Observation, Organization, OrganizationAffiliation, Patient, Practitioner, PractitionerRole, Procedure
- Required developer attestation; HIPAA-aligned data handling
CMS-mandated public Provider Directory FHIR API. No authentication required. Suitable for cached integration into member-facing care navigation, broker tools, and benefits lookups.
- Practitioner, PractitionerRole, Organization, OrganizationAffiliation, Location, InsurancePlan
- Per-plan endpoints (0100, 0500, 0900, 1200, 2100, 2400, 2600)
- No authentication required
CMS-mandated public Drug Formulary surface listing covered medications, tiering, and prior authorization indicators. Documented as a no-authentication surface in the developer portal; formulary content is currently navigable through FHIR MedicationKnowledge / List resources.
- MedicationKnowledge, List resources
- Drug formulary tiers and prior-authorization indicators
- No authentication required
Sources
- https://developer.amerihealthcaritas.com/
- https://developer.amerihealthcaritas.com/dvp/v1/apiadditionaldocsinfo/
- https://www.cms.gov/priorities/key-initiatives/burden-reduction/interoperability
- https://www.amerihealthcaritas.com/find-a-health-plan
Work with this as data
Every plan here is available over the APIs.io API and to AI agents over MCP.