GET api/groups/{groupid}/groupplans/{groupplanid}/ruleclaimlimitspecialdrugs/{id}

Gets a special drug claim limit rule for a given group plan and rule identifier

Request Information

URI Parameters

Name	Description	Type	Additional information
groupid	Group identifier	integer	Required
groupplanid	Group Plan identifier	integer	Required
id	Rule identifier	integer	Required

Body Parameters

None.

Response Information

Resource Description

A special drug claim limit rule

RuleClaimLimitSpecialDrugModel

Name	Description	Type	Additional information
ClaimLimit	Gets or sets the claim limits associated with this rule claim limit	RuleClaimLimitModel	None.
RuleActionTypeUrl	Gets or sets the link to the rule action type resource	string	None.
RuleActionTypeNo	Gets or sets the identifier to the rule action type	integer	None.
EndProcessing	Gets or sets whether more benefit rules are processed if all criteria has been met	boolean	None.
RejectCode	Gets or sets Reject Code for which the rule applies	string	None.
PharmacyPriceMin	Gets or sets the minimum pharmacy price in order for the rule to apply	decimal number	None.
PharmacyPriceMax	Gets or sets the minimum pharmacy price in order for the rule to apply	decimal number	None.
PharmacyPricePreTax	Gets or sets the option for whether the pharmacy price range is the pre-tax amount	boolean	None.
PharmacyPriceCentsMin	Gets or sets the minimum cents portion of the pharmacy price in order for the rule to apply	decimal number	None.
PharmacyPriceCentsMax	Gets or sets the maximum cents portion of the pharmacy price in order for the rule to apply	decimal number	None.
PharmacyPriceCentsPreTax	Gets or sets the option for whether the cents portion of the pharmacy price range is the pre-tax amount	boolean	None.
FirstFillByRx	Gets or sets whether the rule applies to first fills	boolean	None.
RefillExpired	Gets or sets whether the rule applies for expired refills (based on plan's Rx Expire Days)	boolean	None.
MaxFillsPerInterval	Gets or sets the maximum fills allowed for a special drug per interval	integer	None.
MaxFillsIntervalDays	Gets or sets the number of days for the time interval	integer	None.
MaxFillsGraceDays	Gets or sets the number of grace days allowed for the interval period	integer	None.
ClaimTagItemID1	Gets or sets the Claim Tag Item ID 1 identifier	globally unique identifier	None.
ClaimTagItemID2	Gets or sets the Claim Tag Item ID 2 identifier	globally unique identifier	None.
ClaimTagItemID3	Gets or sets the Claim Tag Item ID 3 identifier	globally unique identifier	None.
DependentRelationshipCode	Gets or sets the Dependent Relationship Code	string	None.
DiagnosisCodes	Gets or sets the DiagnosisCodes for which the rule applies	Collection of RuleDiagnosisCodeModel	None.
Networks	Gets or sets networks for which the rule applies; if the list is empty it applies to all	Collection of RuleNetworkModel	None.
Headquarters	Gets or sets headquarters for which the rule applies; if the list is empty it applies to all	Collection of RulePharmacyHeadquarterModel	None.
PharmacyHeadquarterListIsExclusion	Gets or sets a value indicating whether the headquarter list is treated as an exclusion list. If this is true, headquarters in the list will be excluded from the rule; if false, only headquarters in the list will be included in the rule. If the list is empty, it applies to all pharmacies regardless of this value.	boolean	None.
Pharmacies	Gets or sets pharmacies for which the rule applies; if the list is empty it applies to all	Collection of RulePharmacyModel	None.
PharmacyListIsExclusion	Gets or sets a value indicating whether the pharmacy list is treated as an exclusion list. If this is true, pharmacies in the list will be excluded from the rule; if false, only pharmacies in the list will be included in the rule. If the list is empty, it applies to all pharmacies regardless of this value.	boolean	None.
PharmacyProfileListIsExclusion	Gets or sets a value indicating whether the pharmacy profile list is treated as an exclusion list. If this is true, pharmacy profiles in the list will be excluded from the rule; if false, only pharmacy profiles in the list will be included in the rule. If the list is empty, it applies to all pharmacy profiles regardless of this value.	boolean	None.
Facilities	Gets or sets the Facilities for which the rule applies	Collection of RuleFacilityBranchModel	None.
IsOverridden	Gets or sets the flag if this rule is overridden	boolean	None.
OverridingRuleURL	Gets or sets the rule template thats being overridden	string	None.
Enabled	Gets or sets the rule template is enabled	boolean	None.
QuantityMin	Gets or sets the minimum quantity in order for the rule to apply	decimal number	None.
QuantityMax	Gets or sets the maximum quantity in order for the rule to apply	decimal number	None.
CompoundDrugs	Gets whether the special drug criteria applies to compound drugs	boolean	None.
UnknownDrugs	Gets whether the special drug criteria applies to unknown drugs	boolean	None.
UndefinedDrugs	Gets whether the special drug criteria applies to undefined drugs	boolean	None.
CompoundLevelOfEffort	Gets level of effort values applicable to the special drug criteria	Collection of LevelOfEffortModel	None.
GroupPlanNo	Gets or sets the group plan id associated with the rule	integer	None.
Description	Gets or sets the description	string	None.
Priority	Gets or sets the priority	integer	None.
ReferenceCode	Gets or sets the reference code	string	None.
Message	Gets or sets the message	string	None.
ChangeNote	Gets the latest change note or sets a change note to be saved on a patch	string	None.
EffectiveStartDate	Gets or sets the effective start date	date	None.
EffectiveEndDate	Gets or sets the effective end date	date	None.
Active	Gets or sets whether the rule is active	boolean	None.
DaysSupplyMin	Gets or sets the minimum days supply in order for the rule to apply	integer	None.
DaysSupplyMax	Gets or sets the maximum days supply in order for the rule to apply	integer	None.
MemberAgeMin	Gets or sets the minimum age of the member in order for the rule to apply	integer	None.
MemberAgeMax	Gets or sets the maximum age of the member in order for the rule to apply	integer	None.
MemberAgeUnits	Gets or sets the age units.	string	None.
DependentRelationshipCodes	Gets or sets the dependent relationship code as a delimited list for which the rule applies.	Collection of RelationshipModel	None.
ServiceCategory	Gets or sets the service category	string	None.
MemberGender	Gets or sets the gender (if necessary) for which the rule applies	string	None.
PharmacyTypes	Gets or sets the list of acceptable pharmacy types	Collection of RulePharmacyTypeModel	None.
SubmissionClarificationCodeCriteriaType	Gets or sets the rule's submission clarification code match criteria if applicable (possible values: Blank, Match, n/a)	string	None.
SubmissionClarificationCodes	Gets or sets the submission clarification codes for which the rule applies (This list is only used if SubmissionClarificationCodeCriteriaType is set to match)	Collection of RuleSubmissionClarificationCodeModel	None.
PharmacyServiceTypeCriteriaType	Gets or sets the pharmacy service criteria type	string	None.
PharmacyServiceType	Gets or sets the pharmacy service value. Uses standarded NCPDP values.	string	None.
PatientResidenceCriteriaType	Gets or sets the patient residence criteria type	string	None.
PatientResidence	Gets or sets the patient residence value. Uses standarded NCPDP values.	string	None.
PlaceOfServiceCriteriaType	Gets or sets the place of service criteria type	string	None.
PlaceOfService	Gets or sets the place of service value. Uses standarded NCPDP values.	string	None.
BenefitCodeUrl	Gets or sets the Benefit Code Url	string	None.
BenefitCodeNo	Gets or sets the Benefit Code number	integer	None.
PriorFillsGPIChars	Gets or sets the Prior Fills GPI Chars	string	None.
DiagnosisCodeCriteriaType	Gets or sets the rule's submission clarification code match criteria if applicable (possible values: Blank, Match, n/a)	string	None.
DAWCodes	Gets or sets the acceptable DAW code values that apply to the rule	Collection of DAWCodeModel	None.
ContractCodes	Gets or sets the list of contract codes associated with the general criteria	Collection of RuleContractCodeModel	None.
ARCodes	Gets or sets the list of AR codes associated with the general criteria	Collection of RuleARCodeModel	None.
CoverageLevels	Gets or sets the coverage levels associated with the general criteria	Collection of RuleCoverageLevelModel	None.
EmployeeStatuses	Gets or sets the list of employee statuses associated with the general criteria	Collection of RuleEmployeeStatusModel	None.
OtherStatuses	Gets or sets the list of other statuses associated with the general criteria	Collection of RuleOtherStatusModel	None.
PharmacyStates	Gets or sets the list of US States associated with the general criteria	Collection of RuleStateModel	None.
isTemplate	Gets or sets whether the rule is a template	boolean	None.
Url	Gets or sets the link representing a link back to the resource	string	None.
ID	Gets or sets the identifier for the resource	integer	None.

Response Formats

application/json, text/json, application/json-patch+json

Sample:

{
  "url": "sample string 28",
  "id": 29,
  "claimLimit": {
    "allowClaimLimitChecksOnFutureRules": true,
    "quantityLimitPerFill": 1.0,
    "quantityLimitPerDaysSupply": 1.0,
    "quantityLimitPerInterval": 1.0,
    "quantityLimitIntervalDays": 1,
    "quantityLimitGraceDays": 1,
    "quantityLimitPerPeriod": 1.0,
    "quantityLimitPerPeriodGPIChars": "sample string 1",
    "quantityLimitPerYear": 1.0,
    "quantityLimitPerYearGPIChars": "sample string 2",
    "quantityLimitTotal": 1.0,
    "quantityLimitTotalGPIChars": "sample string 3",
    "minDaysSupplyPerFill": 1,
    "maxDaysSupplyPerFill": 1,
    "maxDaysSupplyPerPeriod": 1,
    "maxDaysSupplyPerPeriodGPIChars": "sample string 4",
    "maxDaysSupplyPerYear": 1,
    "maxDaysSupplyPerYearGPIChars": "sample string 5",
    "maxDaysSupplyTotal": 1,
    "maxDaysSupplyTotalGPIChars": "sample string 6",
    "maxPricePerFill": 1.0,
    "maxPricePerFillNetworkResultID": 1,
    "maxPricePerFillNetworkOnly": true,
    "maxPricePerDaySupply": 1.0,
    "maxPricePerDaySupplyNetworkResultID": 1,
    "maxPricePerDaySupplyNetworkOnly": true,
    "maxPricePerUnit": 1.0,
    "maxPricePerUnitNetworkResultID": 1,
    "maxPricePerUnitNetworkOnly": true,
    "refillTooSoonMinPercentConsumed": 1.0,
    "maxFillsPerInterval": 1,
    "maxFillsIntervalDays": 1,
    "maxFillsGraceDays": 1,
    "maxFillsPerPeriod": 1,
    "maxFillsPerPeriodGPIChars": "sample string 7",
    "maxFillsPerYear": 1,
    "maxFillsPerYearGPIChars": "sample string 8",
    "maxFillsTotal": 1,
    "maxFillsTotalGPIChars": "sample string 9",
    "claimLimitsMinMemberAge": 1,
    "claimLimitsMaxMemberAge": 1,
    "claimLimitsMemberAgeUnits": "sample string 10",
    "usualAndCustomaryMarginPercent": 1.0,
    "limitQtyToPackageSize": true,
    "maxFillsPerDaysIntervalSpecial": 1,
    "fillDaysIntervalSpecial": 1,
    "fillGraceDaysSpecial": 1
  },
  "ruleActionTypeUrl": "sample string 1",
  "ruleActionTypeNo": 2,
  "endProcessing": true,
  "rejectCode": "sample string 4",
  "pharmacyPriceMin": 1.0,
  "pharmacyPriceMax": 1.0,
  "pharmacyPricePreTax": true,
  "pharmacyPriceCentsMin": 1.0,
  "pharmacyPriceCentsMax": 1.0,
  "pharmacyPriceCentsPreTax": true,
  "firstFillByRx": true,
  "refillExpired": true,
  "maxFillsPerInterval": 1,
  "maxFillsIntervalDays": 1,
  "maxFillsGraceDays": 1,
  "claimTagItemID1": "ac39cdba-2a4f-4c3f-bd31-c1d06b05c77b",
  "claimTagItemID2": "f16976d8-5ffd-4732-9d00-8572386bfb82",
  "claimTagItemID3": "c1cf917a-0f08-49b3-b1ab-8dde0dd6b010",
  "dependentRelationshipCode": "sample string 5",
  "diagnosisCodes": [
    {
      "url": "sample string 5",
      "id": 6,
      "ruleNo": 1,
      "diagnosisCode": "sample string 2",
      "description": "sample string 3"
    },
    {
      "url": "sample string 5",
      "id": 6,
      "ruleNo": 1,
      "diagnosisCode": "sample string 2",
      "description": "sample string 3"
    }
  ],
  "networks": [
    {
      "url": "sample string 5",
      "id": 6,
      "ruleNo": 1,
      "description": "sample string 2",
      "networkNo": 4
    },
    {
      "url": "sample string 5",
      "id": 6,
      "ruleNo": 1,
      "description": "sample string 2",
      "networkNo": 4
    }
  ],
  "headquarters": [
    {
      "url": "sample string 5",
      "id": 6,
      "ruleNo": 1,
      "description": "sample string 2",
      "pharmacyHeadquarterNo": 4
    },
    {
      "url": "sample string 5",
      "id": 6,
      "ruleNo": 1,
      "description": "sample string 2",
      "pharmacyHeadquarterNo": 4
    }
  ],
  "pharmacyHeadquarterListIsExclusion": true,
  "pharmacies": [
    {
      "url": "sample string 4",
      "id": 5,
      "ruleNo": 1,
      "npi": "sample string 2",
      "pharmacyName": "sample string 3"
    },
    {
      "url": "sample string 4",
      "id": 5,
      "ruleNo": 1,
      "npi": "sample string 2",
      "pharmacyName": "sample string 3"
    }
  ],
  "pharmacyListIsExclusion": true,
  "pharmacyProfileListIsExclusion": true,
  "facilities": [
    {
      "url": "sample string 6",
      "id": 7,
      "ruleNo": 1,
      "facilityName": "sample string 2",
      "pharmacyBranch": "sample string 3",
      "facilityBranchSeqNo": 4
    },
    {
      "url": "sample string 6",
      "id": 7,
      "ruleNo": 1,
      "facilityName": "sample string 2",
      "pharmacyBranch": "sample string 3",
      "facilityBranchSeqNo": 4
    }
  ],
  "quantityMin": 1.0,
  "quantityMax": 1.0,
  "compoundDrugs": true,
  "unknownDrugs": true,
  "undefinedDrugs": true,
  "compoundLevelOfEffort": [
    {
      "displayName": "sample string 1"
    },
    {
      "displayName": "sample string 1"
    }
  ],
  "groupPlanNo": 10,
  "description": "sample string 11",
  "priority": 1,
  "referenceCode": "sample string 12",
  "message": "sample string 13",
  "changeNote": "sample string 14",
  "effectiveStartDate": "2025-12-09T20:14:05.7586878-06:00",
  "effectiveEndDate": "2025-12-09T20:14:05.7586878-06:00",
  "active": true,
  "daysSupplyMin": 1,
  "daysSupplyMax": 1,
  "memberAgeMin": 1,
  "memberAgeMax": 1,
  "memberAgeUnits": "sample string 15",
  "dependentRelationshipCodes": [
    {
      "displayName": "sample string 1"
    },
    {
      "displayName": "sample string 1"
    }
  ],
  "serviceCategory": "sample string 16",
  "memberGender": "sample string 17",
  "pharmacyTypes": [
    {
      "url": "sample string 6",
      "id": 7,
      "ruleNo": 1,
      "description": "sample string 2",
      "pharmacyTypeCode": "sample string 3"
    },
    {
      "url": "sample string 6",
      "id": 7,
      "ruleNo": 1,
      "description": "sample string 2",
      "pharmacyTypeCode": "sample string 3"
    }
  ],
  "submissionClarificationCodeCriteriaType": "sample string 18",
  "submissionClarificationCodes": [
    {
      "url": "sample string 3",
      "id": 4,
      "ruleNo": 1,
      "submissionClarificationCode": "sample string 2"
    },
    {
      "url": "sample string 3",
      "id": 4,
      "ruleNo": 1,
      "submissionClarificationCode": "sample string 2"
    }
  ],
  "pharmacyServiceTypeCriteriaType": "sample string 19",
  "pharmacyServiceType": "sample string 20",
  "patientResidenceCriteriaType": "sample string 21",
  "patientResidence": "sample string 22",
  "placeOfServiceCriteriaType": "sample string 23",
  "placeOfService": "sample string 24",
  "benefitCodeUrl": "sample string 25",
  "benefitCodeNo": 1,
  "priorFillsGPIChars": "sample string 26",
  "diagnosisCodeCriteriaType": "sample string 27",
  "dawCodes": [
    {
      "displayName": "sample string 1"
    },
    {
      "displayName": "sample string 1"
    }
  ],
  "contractCodes": [
    {
      "url": "sample string 3",
      "id": 4,
      "ruleNo": 1,
      "contractCode": "sample string 2"
    },
    {
      "url": "sample string 3",
      "id": 4,
      "ruleNo": 1,
      "contractCode": "sample string 2"
    }
  ],
  "arCodes": [
    {
      "url": "sample string 3",
      "id": 4,
      "ruleNo": 1,
      "arShortCode": "sample string 2"
    },
    {
      "url": "sample string 3",
      "id": 4,
      "ruleNo": 1,
      "arShortCode": "sample string 2"
    }
  ],
  "coverageLevels": [
    {
      "url": "sample string 3",
      "id": 4,
      "ruleNo": 1,
      "coverageLevelCode": "sample string 2"
    },
    {
      "url": "sample string 3",
      "id": 4,
      "ruleNo": 1,
      "coverageLevelCode": "sample string 2"
    }
  ],
  "employeeStatuses": [
    {
      "url": "sample string 3",
      "id": 4,
      "ruleNo": 1,
      "employeeStatus": "sample string 2"
    },
    {
      "url": "sample string 3",
      "id": 4,
      "ruleNo": 1,
      "employeeStatus": "sample string 2"
    }
  ],
  "otherStatuses": [
    {
      "url": "sample string 3",
      "id": 4,
      "ruleNo": 1,
      "otherStatus": "sample string 2"
    },
    {
      "url": "sample string 3",
      "id": 4,
      "ruleNo": 1,
      "otherStatus": "sample string 2"
    }
  ],
  "pharmacyStates": [
    {
      "url": "sample string 3",
      "id": 4,
      "ruleNo": 1,
      "stateCode": "sample string 2"
    },
    {
      "url": "sample string 3",
      "id": 4,
      "ruleNo": 1,
      "stateCode": "sample string 2"
    }
  ],
  "isTemplate": true
}