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Centers for Medicare and Medicaid Services Provider & Drug Coverage API

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

Centers for Medicare and Medicaid Services Provider & Drug Coverage API is one of 16 APIs that Centers for Medicare and 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, and a GitHub repository.

This API exposes 8 operations across 8 paths, and defines 12 schemas. It is described by OpenAPI 2.0, at version 1.

Requests are made against the 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 2.0
API Version
1
Base URL
https://marketplace.api.healthcare.gov/api/v1
Authentication
API Key
Resource Areas
1

Authentication & Security 1

Centers for Medicare and 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
3 params → 200
GET
/drugs/search
Search prescription drugs
3 params → 200
GET
/drugs/covered
Get a list of whether drugs are covered by plans
4 params → 200
GET
/coverage/stats
Coverage statistics
1 param → 200
GET
/coverage/search
Search providers
3 params → 200
GET
/providers/autocomplete
Autocomplete nearby providers
4 params → 200
GET
/providers/search
Search providers
6 params → 200
GET
/providers/covered
Get a list of whether a set of providers are covered by given plans
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.

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

Specification

The full machine-readable OpenAPI contract behind this narrative.

Source

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

Other APIs Centers for Medicare and Medicaid Services publishes across the network.

CMS Beneficiary Claims Data API (BCDA)
CMS AB2D API (Claims Data to Part D Sponsors)
CMS Data at the Point of Care (DPC) API
CMS Finder API
CMS Quality Payment Program (QPP) Submissions API
Centers for Medicare and Medicaid Services API Reference API
Centers for Medicare and Medicaid Services Bulk Data API
Centers for Medicare and Medicaid Services Code Search API
Centers for Medicare and Medicaid Services Cost Search API
Centers for Medicare and Medicaid Services Enrollments API
Centers for Medicare and Medicaid Services Geography API
Centers for Medicare and Medicaid Services Households & Eligibility API