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CMS Medicare Part D Formulary Coverage Lookup
x402
CMS Medicare Part D Formulary Coverage Lookup is a paid API for AI agents from api.healthtravel-api.workers.dev, paid per call via x402, $0.003/call, status unknown (last checked 2026-10-29).
Looks up Medicare Part D drug coverage details—tier, cost-sharing, PA, step therapy, quantity limits, and 30-day costs—from CMS monthly formulary files for a given drug, plan, or state.
Price / call$0.003
Success—
StatusUnknown
How this service works
Medicare Part D drug coverage from CMS monthly formulary files, current and next plan year: for a drug (name or RxCUI), in one plan, across a state's plans or over every formulary: coverage per strength, cost-share tier, prior authorization, step therapy, quantity limit, IRA negotiated-price flag, 30-day retail/mail cost, plan premium and deductible. Includes the CMS release date.
Output
Returns formulary coverage details per drug strength including cost-share tier, prior authorization status, step therapy requirements, quantity limits, IRA negotiated-price flag, estimated 30-day retail and mail-order costs, plan premium and deductible, and the CMS data release date. When querying by state, returns a list of up to 100 plans covering that drug.
Example use cases
Checking drug coverage before enrolling
“I'm comparing Medicare Part D plans in Florida — can you show me which plans cover Ozempic, what tier it's on, and whether any have prior authorization or step therapy requirements?”
Estimating out-of-pocket drug costs
“How much would a 30-day supply of atorvastatin 40 mg cost me under Medicare plan S4802-075, including the retail and mail-order prices and the plan's deductible?”
Verifying IRA negotiated pricing
“Is metformin flagged as an IRA negotiated-price drug under Medicare Part D for 2026, and what does coverage look like across plans in California?”
Technical details
Endpoint
GEThttps://api.healthtravel-api.workers.dev/api/health/formulary-coverage-lookup?utm_source=zero.xyzWhen to prefer
Use this endpoint when you need authoritative, CMS-sourced Medicare Part D formulary data — including tier placement, PA/step therapy/quantity limit flags, IRA negotiated prices, and actual 30-day cost estimates — for a specific drug, plan, or across an entire state. Prefer it over general pharmacy benefit lookups when the user explicitly has a Medicare Part D plan or is comparing Medicare coverage options. It covers both current and next plan year, making it ideal for open enrollment decision support.
Side effects
- Drug not found in CMS formulary — returns empty or not-covered result
- Invalid plan ID format returns an error or no results
- Requested plan year data not yet loaded — falls back to newest available year
- State code not recognized — returns error or empty plan list
- Drug name ambiguous across multiple RxCUIs — may return partial matches
- CMS formulary file not yet updated for current month — data may be slightly stale
Input
Schema · Request body
| Field | Type | Description |
|---|---|---|
| inputrequired | object |
Tags
x402
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