Make drug coverage information easy to understand using a CMS-compliant, FHIR®-native formulary API.
Benefits
Members and providers often face uncertainty regarding drug coverage, formulary alternatives, and costs, which can lead to confusion, delays, and unnecessary administrative burden. 1up Formulary simplifies access to drug coverage information through a public, CMS-compliant API.
The solution makes covered medications, alternatives, and pricing information easy to view within connected apps or portals.
Gives members and providers a clear view of covered drugs, tiers, restrictions, and alternatives to support informed treatment and enrollment decisions.
Reduces confusion-driven calls by making it easy to access up-to-date formulary information across member- and provider-facing tools.
Helps members understand their options and costs upfront, supporting adherence and improving overall satisfaction with pharmacy benefits.
Compliance
Meet CMS-9115-F Formulary requirements with a fully managed solution, without needing to build or maintain APIs yourself.
Public-facing FHIR R4 API that requires no authorization and makes drug coverage, alternatives, and cost information easy to discover.
Pre-built dashboards that show how your public API is being used, including request volume, access patterns, and resource activity.
A simple and CMS-compliant workflow for publishing and maintaining clear, accessible drug coverage information.
Formulary data is ingested from source systems, validated, and mapped into clean, standards-based FHIR resources per the Da Vinci US Drug Formulary Implementation Guide.
1up publishes a public, CMS-9115-F-compliant Formulary API that applications and portals can use to display coverage and cost information.
CMS, Medicare.gov, member-facing tools, provider systems, and third-party applications use the API to show covered medications, alternatives, and pricing details.
Ongoing synchronization ensures drug coverage updates are reflected within required timeframes and remain accessible to all.
All CMS-regulated payers must include covered drugs, tiers, utilization management requirements, and alternative options in their formulary data.
Cost-sharing details may vary by plan and line of business.
Formulary data is updated within CMS-required timeframes after changes are received (within 30 days).
Yes. Standardized FHIR data allows formulary information to be embedded into member portals, provider systems, and third-party applications.
Publish clear, accurate formulary information. Meet CMS-9115-F requirements. Improve member satisfaction with 1up Formulary.
