GET api/groups/{groupid}/groupplans/{groupplanid}/rulepostpricingspecialdrugs
Gets a collection of special drug post pricing rules for a given group plan
Request Information
URI Parameters
Name | Description | Type | Additional information |
---|---|---|---|
groupid |
Group identifier |
integer |
Required |
groupplanid |
Group Plan identifier |
integer |
Required |
Body Parameters
None.
Response Information
Resource Description
A list of special drug post pricing rules
Collection of RulePostPricingSpecialDrugModelName | Description | Type | Additional information |
---|---|---|---|
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. |
PlanPaidMin |
Gets or sets the minimum plan paid amount in order for the rule to apply |
decimal number |
None. |
PlanPaidMax |
Gets or sets the maximum plan paid amount in order for the rule to apply |
decimal number |
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. |
PlanBenefitLimitExceeded |
Gets or sets whether the rule applies to claims when the plan benefit limit is exceeded |
boolean |
None. |
DeductibleMet |
Gets or sets whether the rule applies to claims based on whether the deductible is met |
boolean |
None. |
OutOfPocketLimitMet |
Gets or sets whether the rule applies to claims based on whether the OOP is met |
boolean |
None. |
IsExemptFromDeductible |
Gets or sets whether the rule applies to claims based on whether the deductible is exempt |
boolean |
None. |
IsExemptFromOutOfPocketLimit |
Gets or sets whether the rule applies to claims based on whether the OOP is exempt |
boolean |
None. |
DiagnosisCodes |
Gets or sets the DiagnosisCodes for which the rule applies |
Collection of RuleDiagnosisCodeModel |
None. |
Members |
Gets or sets members for which the rule applies; if the list is empty it applies to all |
Collection of RuleMemberModel |
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. |
Pharmacies |
Gets or sets pharmacies for which the rule applies; if the list is empty it applies to all |
Collection of RulePharmacyModel |
None. |
Prescribers |
Gets or sets prescribers for which the rule applies; if the list is empty it applies to all |
Collection of RulePrescriberModel |
None. |
Facilities |
Gets or sets the Facilities for which the rule applies |
Collection of RuleFacilityBranchModel |
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
[ { "url": "sample string 22", "id": 23, "ruleActionTypeUrl": "sample string 1", "ruleActionTypeNo": 2, "endProcessing": true, "rejectCode": "sample string 3", "pharmacyPriceMin": 1.0, "pharmacyPriceMax": 1.0, "pharmacyPricePreTax": true, "pharmacyPriceCentsMin": 1.0, "pharmacyPriceCentsMax": 1.0, "pharmacyPriceCentsPreTax": true, "planPaidMin": 1.0, "planPaidMax": 1.0, "firstFillByRx": true, "refillExpired": true, "planBenefitLimitExceeded": true, "deductibleMet": true, "outOfPocketLimitMet": true, "isExemptFromDeductible": true, "isExemptFromOutOfPocketLimit": true, "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" } ], "members": [ { "url": "sample string 9", "id": 10, "ruleNo": 1, "lastName": "sample string 2", "firstName": "sample string 3", "middleName": "sample string 4", "dateOfBirth": "2025-05-30T21:43:31.7480979-05:00", "ssn": "sample string 5", "memberSeqNo": 6, "locationName": "sample string 8" }, { "url": "sample string 9", "id": 10, "ruleNo": 1, "lastName": "sample string 2", "firstName": "sample string 3", "middleName": "sample string 4", "dateOfBirth": "2025-05-30T21:43:31.7480979-05:00", "ssn": "sample string 5", "memberSeqNo": 6, "locationName": "sample string 8" } ], "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 } ], "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" } ], "prescribers": [ { "url": "sample string 4", "id": 5, "ruleNo": 1, "npi": "sample string 2", "prescriberName": "sample string 3", "effectiveStartDate": "2025-05-30T21:43:31.7480979-05:00", "effectiveEndDate": "2025-05-30T21:43:31.7480979-05:00" }, { "url": "sample string 4", "id": 5, "ruleNo": 1, "npi": "sample string 2", "prescriberName": "sample string 3", "effectiveStartDate": "2025-05-30T21:43:31.7480979-05:00", "effectiveEndDate": "2025-05-30T21:43:31.7480979-05:00" } ], "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": 4, "description": "sample string 5", "priority": 1, "referenceCode": "sample string 6", "message": "sample string 7", "changeNote": "sample string 8", "effectiveStartDate": "2025-05-30T21:43:31.7480979-05:00", "effectiveEndDate": "2025-05-30T21:43:31.7480979-05:00", "active": true, "daysSupplyMin": 1, "daysSupplyMax": 1, "memberAgeMin": 1, "memberAgeMax": 1, "memberAgeUnits": "sample string 9", "dependentRelationshipCodes": [ { "displayName": "sample string 1" }, { "displayName": "sample string 1" } ], "serviceCategory": "sample string 10", "memberGender": "sample string 11", "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 12", "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 13", "pharmacyServiceType": "sample string 14", "patientResidenceCriteriaType": "sample string 15", "patientResidence": "sample string 16", "placeOfServiceCriteriaType": "sample string 17", "placeOfService": "sample string 18", "benefitCodeUrl": "sample string 19", "benefitCodeNo": 1, "priorFillsGPIChars": "sample string 20", "diagnosisCodeCriteriaType": "sample string 21", "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 }, { "url": "sample string 22", "id": 23, "ruleActionTypeUrl": "sample string 1", "ruleActionTypeNo": 2, "endProcessing": true, "rejectCode": "sample string 3", "pharmacyPriceMin": 1.0, "pharmacyPriceMax": 1.0, "pharmacyPricePreTax": true, "pharmacyPriceCentsMin": 1.0, "pharmacyPriceCentsMax": 1.0, "pharmacyPriceCentsPreTax": true, "planPaidMin": 1.0, "planPaidMax": 1.0, "firstFillByRx": true, "refillExpired": true, "planBenefitLimitExceeded": true, "deductibleMet": true, "outOfPocketLimitMet": true, "isExemptFromDeductible": true, "isExemptFromOutOfPocketLimit": true, "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" } ], "members": [ { "url": "sample string 9", "id": 10, "ruleNo": 1, "lastName": "sample string 2", "firstName": "sample string 3", "middleName": "sample string 4", "dateOfBirth": "2025-05-30T21:43:31.7480979-05:00", "ssn": "sample string 5", "memberSeqNo": 6, "locationName": "sample string 8" }, { "url": "sample string 9", "id": 10, "ruleNo": 1, "lastName": "sample string 2", "firstName": "sample string 3", "middleName": "sample string 4", "dateOfBirth": "2025-05-30T21:43:31.7480979-05:00", "ssn": "sample string 5", "memberSeqNo": 6, "locationName": "sample string 8" } ], "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 } ], "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" } ], "prescribers": [ { "url": "sample string 4", "id": 5, "ruleNo": 1, "npi": "sample string 2", "prescriberName": "sample string 3", "effectiveStartDate": "2025-05-30T21:43:31.7480979-05:00", "effectiveEndDate": "2025-05-30T21:43:31.7480979-05:00" }, { "url": "sample string 4", "id": 5, "ruleNo": 1, "npi": "sample string 2", "prescriberName": "sample string 3", "effectiveStartDate": "2025-05-30T21:43:31.7480979-05:00", "effectiveEndDate": "2025-05-30T21:43:31.7480979-05:00" } ], "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": 4, "description": "sample string 5", "priority": 1, "referenceCode": "sample string 6", "message": "sample string 7", "changeNote": "sample string 8", "effectiveStartDate": "2025-05-30T21:43:31.7480979-05:00", "effectiveEndDate": "2025-05-30T21:43:31.7480979-05:00", "active": true, "daysSupplyMin": 1, "daysSupplyMax": 1, "memberAgeMin": 1, "memberAgeMax": 1, "memberAgeUnits": "sample string 9", "dependentRelationshipCodes": [ { "displayName": "sample string 1" }, { "displayName": "sample string 1" } ], "serviceCategory": "sample string 10", "memberGender": "sample string 11", "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 12", "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 13", "pharmacyServiceType": "sample string 14", "patientResidenceCriteriaType": "sample string 15", "patientResidence": "sample string 16", "placeOfServiceCriteriaType": "sample string 17", "placeOfService": "sample string 18", "benefitCodeUrl": "sample string 19", "benefitCodeNo": 1, "priorFillsGPIChars": "sample string 20", "diagnosisCodeCriteriaType": "sample string 21", "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 } ]