POST api/groups/{groupid}/groupplans/{groupplanid}/rulebenefits

Request Information

URI Parameters

Name	Description	Type	Additional information
groupid		integer	Required
groupplanid		integer	Required

Body Parameters

RuleBenefitModel

Name	Description	Type	Additional information
EndProcessing	Gets or sets whether more benefit rules are processed if all criteria has been met	boolean	None.
DAWEnforceRule	Gets or sets whether to enforce drug criteria checks that would normally be skipped due to DAW	boolean	None.
GenericCoinsuranceUrl	Gets or sets the link to the generic coinsurance resource for the rule	string	None.
GenericCoinsuranceNo	Gets or sets the identifier for the generic coinsurance	integer	None.
GenericOutOfPocketCoinsuranceUrl	Gets or sets the link to the generic out of pocket coinsurance resource for the rule	string	None.
GenericOutOfPocketCoinsuranceNo	Gets or sets the identifier for the generic out of pocket coinsurance	integer	None.
BrandCoinsuranceUrl	Gets or sets the link to the brand coinsurance resource for the rule	string	None.
BrandCoinsuranceNo	Gets or sets the identifier for the brand coinsurance	integer	None.
BrandOutOfPocketCoinsuranceUrl	Gets or sets the link to the brand out of pocket coinsurance resource for the rule	string	None.
BrandOutOfPocketCoinsuranceNo	Gets or sets the identifier for the brand out of pocket coinsurance	integer	None.
PlanBenefitLimitMonthUrl	Gets or sets the link to the monthly plan benefit limit resource for the rule	string	None.
PlanBenefitLimitMonthNo	Gets or sets the monthly plan benefit limit identifier	integer	None.
PlanBenefitLimitPeriodUrl	Gets or sets the link to the periodic plan benefit limit resource for the rule	string	None.
PlanBenefitLimitPeriodNo	Gets or sets the periodic plan benefit limit identifier	integer	None.
PlanBenefitLimitLifeUrl	Gets or sets the link to the lifetime plan benefit limit resource for the rule	string	None.
PlanBenefitLimitLifeNo	Gets or sets the lifetime plan benefit limit identifier	integer	None.
PlanBenefitLimitRxOnlyMonthUrl	Gets or sets the link to the Rx only monthly plan benefit limit resource	string	None.
PlanBenefitLimitRxOnlyMonthNo	Gets or sets the Rx only monthly plan benefit limit identifier	integer	None.
PlanBenefitLimitRxOnlyPeriodUrl	Gets or sets the link to the Rx only periodic plan benefit limit resource	string	None.
PlanBenefitLimitRxOnlyPeriodNo	Gets or sets the Rx only periodic plan benefit limit identifier	integer	None.
PlanBenefitLimitRxOnlyLifeUrl	Gets or sets the link to the Rx only lifetime plan benefit limit resource	string	None.
PlanBenefitLimitRxOnlyLifeNo	Gets or sets the Rx only lifetime plan benefit limit identifier	integer	None.
BrandMaxPlanPaidAmount	Gets or sets whether the max amount that can be applied as the plan responsibility for brand drugs(takes priority over the patient pay limit). Amounts in excess of the cap will be added to the copay.	decimal number	None.
GenericMaxPlanPaidAmount	Gets or sets whether the max amount that can be applied as the plan responsibility for generic drugs(takes priority over the patient pay limit). Amounts in excess of the cap will be added to the copay.	decimal number	None.
BrandMaxPatientPayAmt	Gets or sets whether the max amount that can be applied as the patient responsibility for brand drugs	decimal number	None.
GenericMaxPatientPayAmt	Gets or sets whether the max amount that can be applied as the patient responsibility for generic drugs	decimal number	None.
MaxPatientPayAmtIncludeDrugSelPenalty	Gets or sets whether the drug selection penalties are included in the limit(only applies if an amount is defined)	boolean	None.
MaxPatientPayAmtIncludeMemberClaimFee	Gets or sets whether the member claim fees are included in the limit(only applies if an amount is defined)	boolean	None.
ExemptFromDeductible	Gets or sets whether the rule marks claim as exempt from the deductible	boolean	None.
ExemptFromOutOfPocketLimit	Gets or sets whether the rule marks claim as exempt from max out of pocket limits	boolean	None.
ApplyCoinsuranceAsDeductible	Gets or sets whether the rule applies coinsurance/copay amounts as the deductible amount(even if exempt from deductible)	boolean	None.
DeductibleSplit	Gets or sets whether the percent of the deductible to be paid by the plan	decimal number	None.
IncentiveSplit	Gets or sets whether the percent of the incentive fee to be paid by the plan	decimal number	None.
GenericPlanIncentiveUrl	Gets or sets the link back to the incentive resource for generic drugs for the rule	string	None.
GenericPlanIncentiveNo	Gets or sets the plan incentive identifier for generic drugs	integer	None.
BrandPlanIncentiveUrl	Gets or sets the link back to the plan incentive resource for brand drugs for the rule	string	None.
BrandPlanIncentiveNo	Gets or sets the plan incentive identifier for brand drugs	integer	None.
PeriodDeductibleUrl	Gets or sets the link to the periodic deductible resource for the rule	string	None.
PeriodDeductibleNo	Gets or sets the periodic deductible identifier	integer	None.
PeriodMaxOutOfPocketUrl	Gets or sets the link to the periodic max out of pocket resource for the rule	string	None.
PeriodMaxOutOfPocketNo	Gets or sets the periodic max out of pocket identifier	integer	None.
MonthlyDeductibleUrl	Gets or sets the link to the monthly deductible resource for the rule	string	None.
MonthlyDeductibleNo	Gets or sets the monthly deductible identifier	integer	None.
MonthlyMaxOutOfPocketUrl	Gets or sets the link to the monthly max out of pocket resource	string	None.
MonthlyMaxOutOfPocketNo	Gets or sets the monthly max out of pocket identifier	integer	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.
ShortCycle	Gets or sets whether the rule applies to claims identified as short cycle	boolean	None.
NewStartDrug	Gets or sets whether the rule applies to new a start medication (based on plan's New Start Days)	boolean	None.
NewStartDrugByDrugName	Gets or sets whether the new start drug is based on the drug name (10 digit GPI)	boolean	None.
NewDrug	Gets or sets whether the rule is applied for drugs recently added to the catalog	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.
OnPlan	Gets or sets whether the rule applies when the drug is on the plan	boolean	None.
InCompound	Gets or sets whether the rule applies to compounds being priced using ingredients	boolean	None.
StepTherapy	Gets or sets whether the rule applies to step therapy medication	boolean	None.
DrugSelectionPenaltyUsed	Gets or sets whether the rule applies to claims where a drug penalty has been applied	boolean	None.
OnFormulary	Gets or sets whether the rule on formulary	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.
MemberListIsExclusion	Gets or sets a value indicating whether the member list is treated as an exclusion list. If this is true, members in the list will be excluded from the rule; if false, only members 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.
MemberProfileListIsExclusion	Gets or sets a value indicating whether the member profile list is treated as an exclusion list. If this is true, member profiles in the list will be excluded from the rule; if false, only member profiles 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.
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.
Prescribers	Gets or sets prescribers for which the rule applies; if the list is empty it applies to all	Collection of RulePrescriberModel	None.
PrescriberListIsExclusion	Gets or sets a value indicating whether the prescriber list is treated as an exclusion list. If this is true, prescribers in the list will be excluded from the rule; if false, only prescribers 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.
Facilities	Gets or sets the Facilities for which the rule applies	Collection of RuleFacilityBranchModel	None.
PriorFillsPharmacyPriceMin	Gets or set the prior fills pharmacy price min	decimal number	None.
PriorFillsPharmacyPriceMax	Gets or sets the prior fills pharmacy price max	decimal number	None.
PriorFillsPricePerDaySupplyMin	Gets or sets the prior fills pharmacy price per day supply min	decimal number	None.
PriorFillsPricePerDaySupplyMax	gets or sets the prior fills pharmacy price per day supply max	decimal number	None.
VariableCopayProgramType	Gets or sets flag indicating whether this rule should use variable copay	VariableCopayProgramTypeEnum	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.
IsBrand	Gets or sets whether the drug criteria is based on brand	boolean	None.
IsRx	Gets or sets whether the drug criteria is for prescription only (non-OTC)	boolean	None.
IsMultiSourced	Gets or sets whether the drug criteria is based on multi-source	boolean	None.
IsRepackaged	Gets or sets whether the drug criteria is based on repackaged value	boolean	None.
GenericAvailable	Gets or sets whether the drug criteria applies if a generic is available	boolean	None.
OTCAvailable	Gets or sets whether the drug criteria applies if an OTC is available	boolean	None.
IsMaintenanceDrug	Gets or sets whether the drug criteria applies to maintenance drug	boolean	None.
DEAClassCodes	Gets or sets the applicable DEA schedules for the drug criteria	Collection of DEAScheduleModel	None.
BrandNameCodes	Gets or sets the applicable brand codes for the drug criteria	Collection of BrandNameCodeModel	None.
MultiSourceCodes	Gets or sets the applicable multi-source codes for the drug criteria	Collection of MultiSourceCodeModel	None.
RX_OTCIndicatorCodes	Gets or sets the applicable Rx-OTC Indicator codes for the drug criteria	Collection of RX_OTCIndicatorCodeModel	None.
IncludeCustomDrugs	Gets or sets whether the drug criteria applies to custom drugs	boolean	None.
GPIListIsExclusion	Gets or sets whether the drug criteria GPI list is excluded	boolean	None.
DrugProfileListIsExclusion	Gets or sets whether the drug criteria drug profile list is excluded	boolean	None.
GPIs	Gets or sets the list of GPIs associated with the drug criteria	Collection of RuleGPIModel	None.
PricingGroups	Gets or sets the list of pricing groups associated with the drug criteria	Collection of RulePricingGroupModel	None.
ROAs	Gets or sets the list of ROAs associated with the drug criteria	Collection of RuleROAModel	None.
DosageForms	Gets or sets the dosage forms associated with the drug criteria	Collection of RuleDosageFormModel	None.
FormularyTiers	Gets or sets the list of formulary tiers associated with the drug criteria	Collection of RuleFormularyTierModel	None.
isSpecialty	Gets or Sets a flag indicating whether this rule's criteria should include specialty drugs	boolean	None.
DrugProfiles	Gets or Sets a a list of which drug profiles are associated with this rule	Collection of RuleDrugProfileModel	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.
PriorFillsMin	Gets or sets the Prior Fills Minumum	integer	None.
PriorFillsMax	Gets or sets the Prior Fills Maximum	integer	None.
PriorFillsDaysInterval	Gets or sets the Prior Fills Interval Days	integer	None.
PriorFillsGraceDays	Gets or sets the Prior Fills Grace Days	integer	None.
PriorFillsStartDate	Gets or sets the Prior Fills Start Date	date	None.
PriorFillsDaysSupplyMin	Gets or sets the Prior Fills Days Supply Minimum	integer	None.
PriorFillsDaysSupplyMax	Gets or sets the Prior Fills Days Supply Maximum	integer	None.
PriorFillsDrugProfileUrl	Gets or sets the Prior Fills Drug Profile Url	string	None.
PriorFillsDrugProfileNo	Gets or sets the Prior Fill Drug Profile number	integer	None.
PriorFillsPharmacyProfileUrl	Gets or sets the Prior Fills Pharmacy Profile Url	string	None.
PriorFillsPharmacyProfileNo	Gets or sets the Prior Fills Pharmacy Profile number	integer	None.
PriorFillsGPIChars	Gets or sets the Prior Fills GPI Chars	string	None.
PriorFillsLimitToCurrentPeriod	Gets or sets the Prior Fills Limit to Current Period	boolean	None.
PriorFillsByRxNumber	Gets or sets the Prior Fills Limit to Submitted Rx Number	boolean	None.
PriorFillsByNDC	Gets or sets the Prior Fills Limit to Submitted NDC	boolean	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.
MemberStates	Gets or sets the list of US States associated with the general criteria	Collection of RuleMemberStateModel	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.
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.
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.

Request Formats

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

Sample:

{
  "url": "sample string 44",
  "id": 45,
  "endProcessing": true,
  "dawEnforceRule": true,
  "genericCoinsuranceUrl": "sample string 1",
  "genericCoinsuranceNo": 1,
  "genericOutOfPocketCoinsuranceUrl": "sample string 2",
  "genericOutOfPocketCoinsuranceNo": 1,
  "brandCoinsuranceUrl": "sample string 3",
  "brandCoinsuranceNo": 1,
  "brandOutOfPocketCoinsuranceUrl": "sample string 4",
  "brandOutOfPocketCoinsuranceNo": 1,
  "planBenefitLimitMonthUrl": "sample string 5",
  "planBenefitLimitMonthNo": 1,
  "planBenefitLimitPeriodUrl": "sample string 6",
  "planBenefitLimitPeriodNo": 1,
  "planBenefitLimitLifeUrl": "sample string 7",
  "planBenefitLimitLifeNo": 1,
  "planBenefitLimitRxOnlyMonthUrl": "sample string 8",
  "planBenefitLimitRxOnlyMonthNo": 1,
  "planBenefitLimitRxOnlyPeriodUrl": "sample string 9",
  "planBenefitLimitRxOnlyPeriodNo": 1,
  "planBenefitLimitRxOnlyLifeUrl": "sample string 10",
  "planBenefitLimitRxOnlyLifeNo": 1,
  "brandMaxPlanPaidAmount": 1.0,
  "genericMaxPlanPaidAmount": 1.0,
  "brandMaxPatientPayAmt": 1.0,
  "genericMaxPatientPayAmt": 1.0,
  "maxPatientPayAmtIncludeDrugSelPenalty": true,
  "maxPatientPayAmtIncludeMemberClaimFee": true,
  "exemptFromDeductible": true,
  "exemptFromOutOfPocketLimit": true,
  "applyCoinsuranceAsDeductible": true,
  "deductibleSplit": 1.0,
  "incentiveSplit": 1.0,
  "genericPlanIncentiveUrl": "sample string 11",
  "genericPlanIncentiveNo": 1,
  "brandPlanIncentiveUrl": "sample string 12",
  "brandPlanIncentiveNo": 1,
  "periodDeductibleUrl": "sample string 13",
  "periodDeductibleNo": 1,
  "periodMaxOutOfPocketUrl": "sample string 14",
  "periodMaxOutOfPocketNo": 1,
  "monthlyDeductibleUrl": "sample string 15",
  "monthlyDeductibleNo": 1,
  "monthlyMaxOutOfPocketUrl": "sample string 16",
  "monthlyMaxOutOfPocketNo": 1,
  "pharmacyPriceMin": 1.0,
  "pharmacyPriceMax": 1.0,
  "pharmacyPricePreTax": true,
  "pharmacyPriceCentsMin": 1.0,
  "pharmacyPriceCentsMax": 1.0,
  "pharmacyPriceCentsPreTax": true,
  "shortCycle": true,
  "newStartDrug": true,
  "newStartDrugByDrugName": true,
  "newDrug": true,
  "firstFillByRx": true,
  "refillExpired": true,
  "onPlan": true,
  "inCompound": true,
  "stepTherapy": true,
  "drugSelectionPenaltyUsed": true,
  "onFormulary": 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": "2026-05-07T07:27:46.5749573-05:00",
      "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": "2026-05-07T07:27:46.5749573-05:00",
      "ssn": "sample string 5",
      "memberSeqNo": 6,
      "locationName": "sample string 8"
    }
  ],
  "memberListIsExclusion": true,
  "memberProfileListIsExclusion": true,
  "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",
      "effectiveStartDate": "2026-05-07T07:27:46.5749573-05:00",
      "effectiveEndDate": "2026-05-07T07:27:46.5749573-05:00"
    },
    {
      "url": "sample string 4",
      "id": 5,
      "ruleNo": 1,
      "npi": "sample string 2",
      "pharmacyName": "sample string 3",
      "effectiveStartDate": "2026-05-07T07:27:46.5749573-05:00",
      "effectiveEndDate": "2026-05-07T07:27:46.5749573-05:00"
    }
  ],
  "pharmacyListIsExclusion": true,
  "pharmacyProfileListIsExclusion": true,
  "prescribers": [
    {
      "url": "sample string 4",
      "id": 5,
      "ruleNo": 1,
      "npi": "sample string 2",
      "prescriberName": "sample string 3",
      "effectiveStartDate": "2026-05-07T07:27:46.5749573-05:00",
      "effectiveEndDate": "2026-05-07T07:27:46.5749573-05:00"
    },
    {
      "url": "sample string 4",
      "id": 5,
      "ruleNo": 1,
      "npi": "sample string 2",
      "prescriberName": "sample string 3",
      "effectiveStartDate": "2026-05-07T07:27:46.5749573-05:00",
      "effectiveEndDate": "2026-05-07T07:27:46.5749573-05:00"
    }
  ],
  "prescriberListIsExclusion": 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
    }
  ],
  "priorFillsPharmacyPriceMin": 1.0,
  "priorFillsPharmacyPriceMax": 1.0,
  "priorFillsPricePerDaySupplyMin": 1.0,
  "priorFillsPricePerDaySupplyMax": 1.0,
  "quantityMin": 1.0,
  "quantityMax": 1.0,
  "isBrand": true,
  "isRx": true,
  "isMultiSourced": true,
  "isRepackaged": true,
  "genericAvailable": true,
  "otcAvailable": true,
  "isMaintenanceDrug": true,
  "deaClassCodes": [
    {
      "displayName": "sample string 1"
    },
    {
      "displayName": "sample string 1"
    }
  ],
  "brandNameCodes": [
    {
      "displayName": "sample string 1"
    },
    {
      "displayName": "sample string 1"
    }
  ],
  "multiSourceCodes": [
    {
      "displayName": "sample string 1"
    },
    {
      "displayName": "sample string 1"
    }
  ],
  "rX_OTCIndicatorCodes": [
    {
      "displayName": "sample string 1"
    },
    {
      "displayName": "sample string 1"
    }
  ],
  "includeCustomDrugs": true,
  "gpiListIsExclusion": true,
  "drugProfileListIsExclusion": true,
  "gpIs": [
    {
      "url": "sample string 3",
      "id": 4,
      "ruleNo": 1,
      "genericProductIdentifier": "sample string 2"
    },
    {
      "url": "sample string 3",
      "id": 4,
      "ruleNo": 1,
      "genericProductIdentifier": "sample string 2"
    }
  ],
  "pricingGroups": [
    {
      "url": "sample string 6",
      "id": 7,
      "ruleNo": 1,
      "name": "sample string 2",
      "description": "sample string 3",
      "planPricingGroupNo": 5
    },
    {
      "url": "sample string 6",
      "id": 7,
      "ruleNo": 1,
      "name": "sample string 2",
      "description": "sample string 3",
      "planPricingGroupNo": 5
    }
  ],
  "roAs": [
    {
      "url": "sample string 3",
      "id": 4,
      "ruleNo": 1,
      "routeOfAdministration": "sample string 2"
    },
    {
      "url": "sample string 3",
      "id": 4,
      "ruleNo": 1,
      "routeOfAdministration": "sample string 2"
    }
  ],
  "dosageForms": [
    {
      "url": "sample string 3",
      "id": 4,
      "ruleNo": 1,
      "dosageForm": "sample string 2"
    },
    {
      "url": "sample string 3",
      "id": 4,
      "ruleNo": 1,
      "dosageForm": "sample string 2"
    }
  ],
  "formularyTiers": [
    {
      "url": "sample string 6",
      "id": 7,
      "ruleNo": 1,
      "name": "sample string 2",
      "description": "sample string 3",
      "tier": 1,
      "formularyTierNo": 4
    },
    {
      "url": "sample string 6",
      "id": 7,
      "ruleNo": 1,
      "name": "sample string 2",
      "description": "sample string 3",
      "tier": 1,
      "formularyTierNo": 4
    }
  ],
  "isSpecialty": true,
  "drugProfiles": [
    {
      "url": "sample string 5",
      "id": 6,
      "ruleNo": 1,
      "drugProfileUrl": "sample string 3",
      "drugProfileNo": 4
    },
    {
      "url": "sample string 5",
      "id": 6,
      "ruleNo": 1,
      "drugProfileUrl": "sample string 3",
      "drugProfileNo": 4
    }
  ],
  "groupPlanNo": 23,
  "description": "sample string 24",
  "priority": 1,
  "referenceCode": "sample string 25",
  "message": "sample string 26",
  "changeNote": "sample string 27",
  "effectiveStartDate": "2026-05-07T07:27:46.5749573-05:00",
  "effectiveEndDate": "2026-05-07T07:27:46.5749573-05:00",
  "active": true,
  "daysSupplyMin": 1,
  "daysSupplyMax": 1,
  "memberAgeMin": 1,
  "memberAgeMax": 1,
  "memberAgeUnits": "sample string 28",
  "dependentRelationshipCodes": [
    {
      "displayName": "sample string 1"
    },
    {
      "displayName": "sample string 1"
    }
  ],
  "serviceCategory": "sample string 29",
  "memberGender": "sample string 30",
  "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 31",
  "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 32",
  "pharmacyServiceType": "sample string 33",
  "patientResidenceCriteriaType": "sample string 34",
  "patientResidence": "sample string 35",
  "placeOfServiceCriteriaType": "sample string 36",
  "placeOfService": "sample string 37",
  "benefitCodeUrl": "sample string 38",
  "benefitCodeNo": 1,
  "priorFillsMin": 1,
  "priorFillsMax": 1,
  "priorFillsDaysInterval": 1,
  "priorFillsGraceDays": 1,
  "priorFillsStartDate": "2026-05-07T07:27:46.5749573-05:00",
  "priorFillsDaysSupplyMin": 1,
  "priorFillsDaysSupplyMax": 1,
  "priorFillsDrugProfileUrl": "sample string 39",
  "priorFillsDrugProfileNo": 1,
  "priorFillsPharmacyProfileUrl": "sample string 40",
  "priorFillsPharmacyProfileNo": 1,
  "priorFillsGPIChars": "sample string 41",
  "priorFillsLimitToCurrentPeriod": true,
  "priorFillsByRxNumber": true,
  "priorFillsByNDC": true,
  "diagnosisCodeCriteriaType": "sample string 42",
  "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"
    }
  ],
  "memberStates": [
    {
      "url": "sample string 3",
      "id": 4,
      "ruleNo": 1,
      "stateCode": "sample string 2"
    },
    {
      "url": "sample string 3",
      "id": 4,
      "ruleNo": 1,
      "stateCode": "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
}

application/x-www-form-urlencoded

Sample:

Sample not available.

Response Information

Resource Description

RuleBenefitModel

Name	Description	Type	Additional information
EndProcessing	Gets or sets whether more benefit rules are processed if all criteria has been met	boolean	None.
DAWEnforceRule	Gets or sets whether to enforce drug criteria checks that would normally be skipped due to DAW	boolean	None.
GenericCoinsuranceUrl	Gets or sets the link to the generic coinsurance resource for the rule	string	None.
GenericCoinsuranceNo	Gets or sets the identifier for the generic coinsurance	integer	None.
GenericOutOfPocketCoinsuranceUrl	Gets or sets the link to the generic out of pocket coinsurance resource for the rule	string	None.
GenericOutOfPocketCoinsuranceNo	Gets or sets the identifier for the generic out of pocket coinsurance	integer	None.
BrandCoinsuranceUrl	Gets or sets the link to the brand coinsurance resource for the rule	string	None.
BrandCoinsuranceNo	Gets or sets the identifier for the brand coinsurance	integer	None.
BrandOutOfPocketCoinsuranceUrl	Gets or sets the link to the brand out of pocket coinsurance resource for the rule	string	None.
BrandOutOfPocketCoinsuranceNo	Gets or sets the identifier for the brand out of pocket coinsurance	integer	None.
PlanBenefitLimitMonthUrl	Gets or sets the link to the monthly plan benefit limit resource for the rule	string	None.
PlanBenefitLimitMonthNo	Gets or sets the monthly plan benefit limit identifier	integer	None.
PlanBenefitLimitPeriodUrl	Gets or sets the link to the periodic plan benefit limit resource for the rule	string	None.
PlanBenefitLimitPeriodNo	Gets or sets the periodic plan benefit limit identifier	integer	None.
PlanBenefitLimitLifeUrl	Gets or sets the link to the lifetime plan benefit limit resource for the rule	string	None.
PlanBenefitLimitLifeNo	Gets or sets the lifetime plan benefit limit identifier	integer	None.
PlanBenefitLimitRxOnlyMonthUrl	Gets or sets the link to the Rx only monthly plan benefit limit resource	string	None.
PlanBenefitLimitRxOnlyMonthNo	Gets or sets the Rx only monthly plan benefit limit identifier	integer	None.
PlanBenefitLimitRxOnlyPeriodUrl	Gets or sets the link to the Rx only periodic plan benefit limit resource	string	None.
PlanBenefitLimitRxOnlyPeriodNo	Gets or sets the Rx only periodic plan benefit limit identifier	integer	None.
PlanBenefitLimitRxOnlyLifeUrl	Gets or sets the link to the Rx only lifetime plan benefit limit resource	string	None.
PlanBenefitLimitRxOnlyLifeNo	Gets or sets the Rx only lifetime plan benefit limit identifier	integer	None.
BrandMaxPlanPaidAmount	Gets or sets whether the max amount that can be applied as the plan responsibility for brand drugs(takes priority over the patient pay limit). Amounts in excess of the cap will be added to the copay.	decimal number	None.
GenericMaxPlanPaidAmount	Gets or sets whether the max amount that can be applied as the plan responsibility for generic drugs(takes priority over the patient pay limit). Amounts in excess of the cap will be added to the copay.	decimal number	None.
BrandMaxPatientPayAmt	Gets or sets whether the max amount that can be applied as the patient responsibility for brand drugs	decimal number	None.
GenericMaxPatientPayAmt	Gets or sets whether the max amount that can be applied as the patient responsibility for generic drugs	decimal number	None.
MaxPatientPayAmtIncludeDrugSelPenalty	Gets or sets whether the drug selection penalties are included in the limit(only applies if an amount is defined)	boolean	None.
MaxPatientPayAmtIncludeMemberClaimFee	Gets or sets whether the member claim fees are included in the limit(only applies if an amount is defined)	boolean	None.
ExemptFromDeductible	Gets or sets whether the rule marks claim as exempt from the deductible	boolean	None.
ExemptFromOutOfPocketLimit	Gets or sets whether the rule marks claim as exempt from max out of pocket limits	boolean	None.
ApplyCoinsuranceAsDeductible	Gets or sets whether the rule applies coinsurance/copay amounts as the deductible amount(even if exempt from deductible)	boolean	None.
DeductibleSplit	Gets or sets whether the percent of the deductible to be paid by the plan	decimal number	None.
IncentiveSplit	Gets or sets whether the percent of the incentive fee to be paid by the plan	decimal number	None.
GenericPlanIncentiveUrl	Gets or sets the link back to the incentive resource for generic drugs for the rule	string	None.
GenericPlanIncentiveNo	Gets or sets the plan incentive identifier for generic drugs	integer	None.
BrandPlanIncentiveUrl	Gets or sets the link back to the plan incentive resource for brand drugs for the rule	string	None.
BrandPlanIncentiveNo	Gets or sets the plan incentive identifier for brand drugs	integer	None.
PeriodDeductibleUrl	Gets or sets the link to the periodic deductible resource for the rule	string	None.
PeriodDeductibleNo	Gets or sets the periodic deductible identifier	integer	None.
PeriodMaxOutOfPocketUrl	Gets or sets the link to the periodic max out of pocket resource for the rule	string	None.
PeriodMaxOutOfPocketNo	Gets or sets the periodic max out of pocket identifier	integer	None.
MonthlyDeductibleUrl	Gets or sets the link to the monthly deductible resource for the rule	string	None.
MonthlyDeductibleNo	Gets or sets the monthly deductible identifier	integer	None.
MonthlyMaxOutOfPocketUrl	Gets or sets the link to the monthly max out of pocket resource	string	None.
MonthlyMaxOutOfPocketNo	Gets or sets the monthly max out of pocket identifier	integer	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.
ShortCycle	Gets or sets whether the rule applies to claims identified as short cycle	boolean	None.
NewStartDrug	Gets or sets whether the rule applies to new a start medication (based on plan's New Start Days)	boolean	None.
NewStartDrugByDrugName	Gets or sets whether the new start drug is based on the drug name (10 digit GPI)	boolean	None.
NewDrug	Gets or sets whether the rule is applied for drugs recently added to the catalog	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.
OnPlan	Gets or sets whether the rule applies when the drug is on the plan	boolean	None.
InCompound	Gets or sets whether the rule applies to compounds being priced using ingredients	boolean	None.
StepTherapy	Gets or sets whether the rule applies to step therapy medication	boolean	None.
DrugSelectionPenaltyUsed	Gets or sets whether the rule applies to claims where a drug penalty has been applied	boolean	None.
OnFormulary	Gets or sets whether the rule on formulary	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.
MemberListIsExclusion	Gets or sets a value indicating whether the member list is treated as an exclusion list. If this is true, members in the list will be excluded from the rule; if false, only members 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.
MemberProfileListIsExclusion	Gets or sets a value indicating whether the member profile list is treated as an exclusion list. If this is true, member profiles in the list will be excluded from the rule; if false, only member profiles 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.
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.
Prescribers	Gets or sets prescribers for which the rule applies; if the list is empty it applies to all	Collection of RulePrescriberModel	None.
PrescriberListIsExclusion	Gets or sets a value indicating whether the prescriber list is treated as an exclusion list. If this is true, prescribers in the list will be excluded from the rule; if false, only prescribers 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.
Facilities	Gets or sets the Facilities for which the rule applies	Collection of RuleFacilityBranchModel	None.
PriorFillsPharmacyPriceMin	Gets or set the prior fills pharmacy price min	decimal number	None.
PriorFillsPharmacyPriceMax	Gets or sets the prior fills pharmacy price max	decimal number	None.
PriorFillsPricePerDaySupplyMin	Gets or sets the prior fills pharmacy price per day supply min	decimal number	None.
PriorFillsPricePerDaySupplyMax	gets or sets the prior fills pharmacy price per day supply max	decimal number	None.
VariableCopayProgramType	Gets or sets flag indicating whether this rule should use variable copay	VariableCopayProgramTypeEnum	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.
IsBrand	Gets or sets whether the drug criteria is based on brand	boolean	None.
IsRx	Gets or sets whether the drug criteria is for prescription only (non-OTC)	boolean	None.
IsMultiSourced	Gets or sets whether the drug criteria is based on multi-source	boolean	None.
IsRepackaged	Gets or sets whether the drug criteria is based on repackaged value	boolean	None.
GenericAvailable	Gets or sets whether the drug criteria applies if a generic is available	boolean	None.
OTCAvailable	Gets or sets whether the drug criteria applies if an OTC is available	boolean	None.
IsMaintenanceDrug	Gets or sets whether the drug criteria applies to maintenance drug	boolean	None.
DEAClassCodes	Gets or sets the applicable DEA schedules for the drug criteria	Collection of DEAScheduleModel	None.
BrandNameCodes	Gets or sets the applicable brand codes for the drug criteria	Collection of BrandNameCodeModel	None.
MultiSourceCodes	Gets or sets the applicable multi-source codes for the drug criteria	Collection of MultiSourceCodeModel	None.
RX_OTCIndicatorCodes	Gets or sets the applicable Rx-OTC Indicator codes for the drug criteria	Collection of RX_OTCIndicatorCodeModel	None.
IncludeCustomDrugs	Gets or sets whether the drug criteria applies to custom drugs	boolean	None.
GPIListIsExclusion	Gets or sets whether the drug criteria GPI list is excluded	boolean	None.
DrugProfileListIsExclusion	Gets or sets whether the drug criteria drug profile list is excluded	boolean	None.
GPIs	Gets or sets the list of GPIs associated with the drug criteria	Collection of RuleGPIModel	None.
PricingGroups	Gets or sets the list of pricing groups associated with the drug criteria	Collection of RulePricingGroupModel	None.
ROAs	Gets or sets the list of ROAs associated with the drug criteria	Collection of RuleROAModel	None.
DosageForms	Gets or sets the dosage forms associated with the drug criteria	Collection of RuleDosageFormModel	None.
FormularyTiers	Gets or sets the list of formulary tiers associated with the drug criteria	Collection of RuleFormularyTierModel	None.
isSpecialty	Gets or Sets a flag indicating whether this rule's criteria should include specialty drugs	boolean	None.
DrugProfiles	Gets or Sets a a list of which drug profiles are associated with this rule	Collection of RuleDrugProfileModel	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.
PriorFillsMin	Gets or sets the Prior Fills Minumum	integer	None.
PriorFillsMax	Gets or sets the Prior Fills Maximum	integer	None.
PriorFillsDaysInterval	Gets or sets the Prior Fills Interval Days	integer	None.
PriorFillsGraceDays	Gets or sets the Prior Fills Grace Days	integer	None.
PriorFillsStartDate	Gets or sets the Prior Fills Start Date	date	None.
PriorFillsDaysSupplyMin	Gets or sets the Prior Fills Days Supply Minimum	integer	None.
PriorFillsDaysSupplyMax	Gets or sets the Prior Fills Days Supply Maximum	integer	None.
PriorFillsDrugProfileUrl	Gets or sets the Prior Fills Drug Profile Url	string	None.
PriorFillsDrugProfileNo	Gets or sets the Prior Fill Drug Profile number	integer	None.
PriorFillsPharmacyProfileUrl	Gets or sets the Prior Fills Pharmacy Profile Url	string	None.
PriorFillsPharmacyProfileNo	Gets or sets the Prior Fills Pharmacy Profile number	integer	None.
PriorFillsGPIChars	Gets or sets the Prior Fills GPI Chars	string	None.
PriorFillsLimitToCurrentPeriod	Gets or sets the Prior Fills Limit to Current Period	boolean	None.
PriorFillsByRxNumber	Gets or sets the Prior Fills Limit to Submitted Rx Number	boolean	None.
PriorFillsByNDC	Gets or sets the Prior Fills Limit to Submitted NDC	boolean	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.
MemberStates	Gets or sets the list of US States associated with the general criteria	Collection of RuleMemberStateModel	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.
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.
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 44",
  "id": 45,
  "endProcessing": true,
  "dawEnforceRule": true,
  "genericCoinsuranceUrl": "sample string 1",
  "genericCoinsuranceNo": 1,
  "genericOutOfPocketCoinsuranceUrl": "sample string 2",
  "genericOutOfPocketCoinsuranceNo": 1,
  "brandCoinsuranceUrl": "sample string 3",
  "brandCoinsuranceNo": 1,
  "brandOutOfPocketCoinsuranceUrl": "sample string 4",
  "brandOutOfPocketCoinsuranceNo": 1,
  "planBenefitLimitMonthUrl": "sample string 5",
  "planBenefitLimitMonthNo": 1,
  "planBenefitLimitPeriodUrl": "sample string 6",
  "planBenefitLimitPeriodNo": 1,
  "planBenefitLimitLifeUrl": "sample string 7",
  "planBenefitLimitLifeNo": 1,
  "planBenefitLimitRxOnlyMonthUrl": "sample string 8",
  "planBenefitLimitRxOnlyMonthNo": 1,
  "planBenefitLimitRxOnlyPeriodUrl": "sample string 9",
  "planBenefitLimitRxOnlyPeriodNo": 1,
  "planBenefitLimitRxOnlyLifeUrl": "sample string 10",
  "planBenefitLimitRxOnlyLifeNo": 1,
  "brandMaxPlanPaidAmount": 1.0,
  "genericMaxPlanPaidAmount": 1.0,
  "brandMaxPatientPayAmt": 1.0,
  "genericMaxPatientPayAmt": 1.0,
  "maxPatientPayAmtIncludeDrugSelPenalty": true,
  "maxPatientPayAmtIncludeMemberClaimFee": true,
  "exemptFromDeductible": true,
  "exemptFromOutOfPocketLimit": true,
  "applyCoinsuranceAsDeductible": true,
  "deductibleSplit": 1.0,
  "incentiveSplit": 1.0,
  "genericPlanIncentiveUrl": "sample string 11",
  "genericPlanIncentiveNo": 1,
  "brandPlanIncentiveUrl": "sample string 12",
  "brandPlanIncentiveNo": 1,
  "periodDeductibleUrl": "sample string 13",
  "periodDeductibleNo": 1,
  "periodMaxOutOfPocketUrl": "sample string 14",
  "periodMaxOutOfPocketNo": 1,
  "monthlyDeductibleUrl": "sample string 15",
  "monthlyDeductibleNo": 1,
  "monthlyMaxOutOfPocketUrl": "sample string 16",
  "monthlyMaxOutOfPocketNo": 1,
  "pharmacyPriceMin": 1.0,
  "pharmacyPriceMax": 1.0,
  "pharmacyPricePreTax": true,
  "pharmacyPriceCentsMin": 1.0,
  "pharmacyPriceCentsMax": 1.0,
  "pharmacyPriceCentsPreTax": true,
  "shortCycle": true,
  "newStartDrug": true,
  "newStartDrugByDrugName": true,
  "newDrug": true,
  "firstFillByRx": true,
  "refillExpired": true,
  "onPlan": true,
  "inCompound": true,
  "stepTherapy": true,
  "drugSelectionPenaltyUsed": true,
  "onFormulary": 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": "2026-05-07T07:27:46.5769554-05:00",
      "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": "2026-05-07T07:27:46.5769554-05:00",
      "ssn": "sample string 5",
      "memberSeqNo": 6,
      "locationName": "sample string 8"
    }
  ],
  "memberListIsExclusion": true,
  "memberProfileListIsExclusion": true,
  "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",
      "effectiveStartDate": "2026-05-07T07:27:46.5769554-05:00",
      "effectiveEndDate": "2026-05-07T07:27:46.5769554-05:00"
    },
    {
      "url": "sample string 4",
      "id": 5,
      "ruleNo": 1,
      "npi": "sample string 2",
      "pharmacyName": "sample string 3",
      "effectiveStartDate": "2026-05-07T07:27:46.5769554-05:00",
      "effectiveEndDate": "2026-05-07T07:27:46.5769554-05:00"
    }
  ],
  "pharmacyListIsExclusion": true,
  "pharmacyProfileListIsExclusion": true,
  "prescribers": [
    {
      "url": "sample string 4",
      "id": 5,
      "ruleNo": 1,
      "npi": "sample string 2",
      "prescriberName": "sample string 3",
      "effectiveStartDate": "2026-05-07T07:27:46.5769554-05:00",
      "effectiveEndDate": "2026-05-07T07:27:46.5769554-05:00"
    },
    {
      "url": "sample string 4",
      "id": 5,
      "ruleNo": 1,
      "npi": "sample string 2",
      "prescriberName": "sample string 3",
      "effectiveStartDate": "2026-05-07T07:27:46.5769554-05:00",
      "effectiveEndDate": "2026-05-07T07:27:46.5769554-05:00"
    }
  ],
  "prescriberListIsExclusion": 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
    }
  ],
  "priorFillsPharmacyPriceMin": 1.0,
  "priorFillsPharmacyPriceMax": 1.0,
  "priorFillsPricePerDaySupplyMin": 1.0,
  "priorFillsPricePerDaySupplyMax": 1.0,
  "quantityMin": 1.0,
  "quantityMax": 1.0,
  "isBrand": true,
  "isRx": true,
  "isMultiSourced": true,
  "isRepackaged": true,
  "genericAvailable": true,
  "otcAvailable": true,
  "isMaintenanceDrug": true,
  "deaClassCodes": [
    {
      "displayName": "sample string 1"
    },
    {
      "displayName": "sample string 1"
    }
  ],
  "brandNameCodes": [
    {
      "displayName": "sample string 1"
    },
    {
      "displayName": "sample string 1"
    }
  ],
  "multiSourceCodes": [
    {
      "displayName": "sample string 1"
    },
    {
      "displayName": "sample string 1"
    }
  ],
  "rX_OTCIndicatorCodes": [
    {
      "displayName": "sample string 1"
    },
    {
      "displayName": "sample string 1"
    }
  ],
  "includeCustomDrugs": true,
  "gpiListIsExclusion": true,
  "drugProfileListIsExclusion": true,
  "gpIs": [
    {
      "url": "sample string 3",
      "id": 4,
      "ruleNo": 1,
      "genericProductIdentifier": "sample string 2"
    },
    {
      "url": "sample string 3",
      "id": 4,
      "ruleNo": 1,
      "genericProductIdentifier": "sample string 2"
    }
  ],
  "pricingGroups": [
    {
      "url": "sample string 6",
      "id": 7,
      "ruleNo": 1,
      "name": "sample string 2",
      "description": "sample string 3",
      "planPricingGroupNo": 5
    },
    {
      "url": "sample string 6",
      "id": 7,
      "ruleNo": 1,
      "name": "sample string 2",
      "description": "sample string 3",
      "planPricingGroupNo": 5
    }
  ],
  "roAs": [
    {
      "url": "sample string 3",
      "id": 4,
      "ruleNo": 1,
      "routeOfAdministration": "sample string 2"
    },
    {
      "url": "sample string 3",
      "id": 4,
      "ruleNo": 1,
      "routeOfAdministration": "sample string 2"
    }
  ],
  "dosageForms": [
    {
      "url": "sample string 3",
      "id": 4,
      "ruleNo": 1,
      "dosageForm": "sample string 2"
    },
    {
      "url": "sample string 3",
      "id": 4,
      "ruleNo": 1,
      "dosageForm": "sample string 2"
    }
  ],
  "formularyTiers": [
    {
      "url": "sample string 6",
      "id": 7,
      "ruleNo": 1,
      "name": "sample string 2",
      "description": "sample string 3",
      "tier": 1,
      "formularyTierNo": 4
    },
    {
      "url": "sample string 6",
      "id": 7,
      "ruleNo": 1,
      "name": "sample string 2",
      "description": "sample string 3",
      "tier": 1,
      "formularyTierNo": 4
    }
  ],
  "isSpecialty": true,
  "drugProfiles": [
    {
      "url": "sample string 5",
      "id": 6,
      "ruleNo": 1,
      "drugProfileUrl": "sample string 3",
      "drugProfileNo": 4
    },
    {
      "url": "sample string 5",
      "id": 6,
      "ruleNo": 1,
      "drugProfileUrl": "sample string 3",
      "drugProfileNo": 4
    }
  ],
  "groupPlanNo": 23,
  "description": "sample string 24",
  "priority": 1,
  "referenceCode": "sample string 25",
  "message": "sample string 26",
  "changeNote": "sample string 27",
  "effectiveStartDate": "2026-05-07T07:27:46.5769554-05:00",
  "effectiveEndDate": "2026-05-07T07:27:46.5769554-05:00",
  "active": true,
  "daysSupplyMin": 1,
  "daysSupplyMax": 1,
  "memberAgeMin": 1,
  "memberAgeMax": 1,
  "memberAgeUnits": "sample string 28",
  "dependentRelationshipCodes": [
    {
      "displayName": "sample string 1"
    },
    {
      "displayName": "sample string 1"
    }
  ],
  "serviceCategory": "sample string 29",
  "memberGender": "sample string 30",
  "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 31",
  "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 32",
  "pharmacyServiceType": "sample string 33",
  "patientResidenceCriteriaType": "sample string 34",
  "patientResidence": "sample string 35",
  "placeOfServiceCriteriaType": "sample string 36",
  "placeOfService": "sample string 37",
  "benefitCodeUrl": "sample string 38",
  "benefitCodeNo": 1,
  "priorFillsMin": 1,
  "priorFillsMax": 1,
  "priorFillsDaysInterval": 1,
  "priorFillsGraceDays": 1,
  "priorFillsStartDate": "2026-05-07T07:27:46.5769554-05:00",
  "priorFillsDaysSupplyMin": 1,
  "priorFillsDaysSupplyMax": 1,
  "priorFillsDrugProfileUrl": "sample string 39",
  "priorFillsDrugProfileNo": 1,
  "priorFillsPharmacyProfileUrl": "sample string 40",
  "priorFillsPharmacyProfileNo": 1,
  "priorFillsGPIChars": "sample string 41",
  "priorFillsLimitToCurrentPeriod": true,
  "priorFillsByRxNumber": true,
  "priorFillsByNDC": true,
  "diagnosisCodeCriteriaType": "sample string 42",
  "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"
    }
  ],
  "memberStates": [
    {
      "url": "sample string 3",
      "id": 4,
      "ruleNo": 1,
      "stateCode": "sample string 2"
    },
    {
      "url": "sample string 3",
      "id": 4,
      "ruleNo": 1,
      "stateCode": "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
}