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CMS — Centers for Medicare & Medicaid Services Provider & Drug Coverage API

Lookup information on providers, drugs, and what is covered under what plans.

CMS — Centers for Medicare & Medicaid Services Provider & Drug Coverage API is one of 56 APIs that CMS — Centers for Medicare & Medicaid Services publishes on the APIs.io network, described by a machine-readable OpenAPI specification.

Tagged areas include Provider & Drug Coverage. The published artifact set on APIs.io includes an OpenAPI specification, API documentation, authentication docs, a GitHub repository, a changelog, and an API reference.

This API exposes 8 operations across 8 paths, and defines 12 schemas. It is described by OpenAPI 3.2.0, at version 1.

Requests are made against a single base URL, https://marketplace.api.healthcare.gov/api/v1.

8 operations 8 paths 12 schemas 8 GET

Metadata

The identity and technical contract details declared by the specification.

Specification
OpenAPI 3.2.0
API Version
1
Base URL
https://api.bluebutton.cms.gov/v2/fhir
Authentication
API Key
Resource Areas
1

Authentication & Security 1

CMS — Centers for Medicare & Medicaid Services Provider & Drug Coverage API declares 1 security scheme for authenticating requests. An API key is passed in the query as apikey (API_Key). By default, every request must be authenticated.

  • API_Key — 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/SV4N2GHCJfNuX7n8x)…

Paths & Operations 8

Across 8 paths, the API surfaces 8 operations — 8 GET. Each is listed below with its method, path, parameters, and response codes.

Provider & Drug Coverage 8

Lookup information on providers, drugs, and what is covered under what plans.

GET
/drugs/autocomplete
Autocomplete drugs by name
getDrugsAutocomplete 3 params → 200
GET
/drugs/search
Search prescription drugs
getDrugsSearch 3 params → 200
GET
/drugs/covered
Get a list of whether drugs are covered by plans
getDrugsCovered 4 params → 200
GET
/coverage/stats
Coverage statistics
getCoverageStats 1 param → 200
GET
/coverage/search
Search providers
getCoverageSearch 3 params → 200
GET
/providers/autocomplete
Autocomplete nearby providers
getProvidersAutocomplete 4 params → 200
GET
/providers/search
Search providers
getProvidersSearch 6 params → 200
GET
/providers/covered
Get a list of whether a set of providers are covered by given plans
getProvidersCovered 4 params → 200

Schemas 12

The contract defines 12 schemas that model the data the API accepts and returns. The most detailed are Provider (9 properties), Drug (8 properties), Address (6 properties), ProviderCoverage (5 properties). Each schema is shown below with its type and property counts.

Provider
object
9 properties 3 required
DrugCoverage
object
4 properties
NearbyProvider
object
3 properties 2 required
RxCUI
string
Coverage
string
NPI
string
ProviderCoverage
object
5 properties
ProviderTypeEnum
string
Address
object
6 properties
ProviderGenderEnum
string
PlanID
string
Drug
object
8 properties

Specification

The full machine-readable OpenAPI contract behind this narrative.

Source

cms-gov-provider-drug-coverage-api-openapi.yml Raw ↑

Other APIs CMS — Centers for Medicare & Medicaid Services publishes across the network.

CMS — Centers for Medicare & Medicaid Services Articles API
CMS — Centers for Medicare & Medicaid Services Auth API
CMS — Centers for Medicare & Medicaid Services Benchmarks API
CMS — Centers for Medicare & Medicaid Services Bulk Export API
CMS — Centers for Medicare & Medicaid Services Catalog API
CMS — Centers for Medicare & Medicaid Services Coverage API
CMS — Centers for Medicare & Medicaid Services Data API
CMS — Centers for Medicare & Medicaid Services Drugs API
CMS — Centers for Medicare & Medicaid Services Eligibility API
CMS — Centers for Medicare & Medicaid Services ExplanationOfBenefit API
CMS — Centers for Medicare & Medicaid Services Geography API
CMS — Centers for Medicare & Medicaid Services Group API
Where this information came from

This is an independent, third-party profile of CMS — Centers for Medicare & Medicaid Services Provider & Drug Coverage API, published by API Evangelist. We do not operate, host, resell, or support these APIs, and we are not affiliated with or endorsed by the company unless stated above. Everything here is built from publicly available information — the company's own site, developer portal, documentation, public repositories, and the specifications it publishes for public use. Nothing is obtained by breaching a system, defeating an access control, or using credentials.

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