RuleBenefitNDCSpecificModel

Gets or sets whether more benefit rules are processed if all criteria has been met

Gets or sets whether to enforce drug criteria checks that would normally be skipped due to DAW

Gets or sets the link to the generic coinsurance resource for the rule

Gets or sets the identifier for the generic coinsurance

Gets or sets the link to the generic out of pocket coinsurance resource for the rule

Gets or sets the identifier for the generic out of pocket coinsurance

Gets or sets the link to the brand coinsurance resource for the rule

Gets or sets the identifier for the brand coinsurance

Gets or sets the link to the brand out of pocket coinsurance resource for the rule

Gets or sets the identifier for the brand out of pocket coinsurance

Gets or sets the link to the monthly plan benefit limit resource for the rule

Gets or sets the monthly plan benefit limit identifier

Gets or sets the link to the periodic plan benefit limit resource for the rule

Gets or sets the periodic plan benefit limit identifier

Gets or sets the link to the lifetime plan benefit limit resource for the rule

Gets or sets the lifetime plan benefit limit identifier

Gets or sets the link to the Rx only monthly plan benefit limit resource

Gets or sets the Rx only monthly plan benefit limit identifier

Gets or sets the link to the Rx only periodic plan benefit limit resource

Gets or sets the Rx only periodic plan benefit limit identifier

Gets or sets the link to the Rx only lifetime plan benefit limit resource

Gets or sets the Rx only lifetime plan benefit limit identifier

Gets or sets whether the rule marks claim as exempt from the deductible

Gets or sets whether the rule marks claim as exempt from max out of pocket limits

Gets or sets the link back to the incentive resource for generic drugs for the rule

Gets or sets the plan incentive identifier for generic drugs

Gets or sets the link back to the plan incentive resource for brand drugs for the rule

Gets or sets the plan incentive identifier for brand drugs

Gets or sets the link to the periodic deductible resource for the rule

Gets or sets the periodic deductible identifier

Gets or sets the link to the periodic max out of pocket resource for the rule

Gets or sets the periodic max out of pocket identifier

Gets or sets the link to the monthly deductible resource for the rule

Gets or sets the monthly deductible identifier

Gets or sets the link to the monthly max out of pocket resource

Gets or sets the monthly max out of pocket identifier

Gets or sets the minimum pharmacy price in order for the rule to apply

Gets or sets the minimum pharmacy price in order for the rule to apply

Gets or sets the option for whether the pharmacy price range is the pre-tax amount

Gets or sets the minimum cents portion of the pharmacy price in order for the rule to apply

Gets or sets the maximum cents portion of the pharmacy price in order for the rule to apply

Gets or sets the option for whether the cents portion of the pharmacy price range is the pre-tax amount

Gets or sets whether the rule applies to claims identified as short cycle

Gets or sets whether the rule applies to new a start medication (based on plan's New Start Days)

Gets or sets whether the new start drug is based on the drug name (10 digit GPI)

Gets or sets whether the rule is applied for drugs recently added to the catalog

Gets or sets whether the rule applies to first fills

Gets or sets whether the rule applies for expired refills (based on plan's Rx Expire Days)

Gets or sets whether the rule applies when the drug is on the plan

Gets or sets whether the rule applies to compounds being priced using ingredients

Gets or sets whether the rule applies to step therapy medication

Gets or sets whether the rule applies to claims where a drug penalty has been applied

Gets or sets whether the rule on formulary

Gets or sets the DiagnosisCodes for which the rule applies

Gets or sets members for which the rule applies; if the list is empty it applies to all

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.

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.

Gets or sets networks for which the rule applies; if the list is empty it applies to all

Gets or sets headquarters for which the rule applies; if the list is empty it applies to all

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.

Gets or sets pharmacies for which the rule applies; if the list is empty it applies to all

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.

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.

Gets or sets prescribers for which the rule applies; if the list is empty it applies to all

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.

Gets or sets the Facilities for which the rule applies

Gets or sets a value indicating whether the ndc list is treated as an exclusion list. If this is true, ndcs in the list will be excluded from the rule; if false, only ndcs in the list will be included in the rule. If the list is empty, it applies to all pharmacies regardless of this value.

Gets or sets flag indicating whether this rule should use variable copay

Gets or sets the minimum quantity in order for the rule to apply

Gets or sets the maximum quantity in order for the rule to apply

Gets or sets the list of NDCs associated with the rule criteria. These values can be posted/added at individual rule controllers, but should be patched at the RuleDrug endpoint - api/groups/{groupid}/groupplans/{groupplanid}/rules/{ruleid}/ruledrugs/{id}.

Gets or sets the list of pricing groups associated with the drug criteria

Gets or sets the list of formulary tiers associated with the drug criteria

Gets or Sets a flag indicating whether this rule's criteria should include specialty drugs

Gets or sets the group plan id associated with the rule

Gets or sets the description

Gets or sets the priority

Gets or sets the reference code

Gets or sets the message

Gets the latest change note or sets a change note to be saved on a patch

Gets or sets the effective start date

Gets or sets the effective end date

Gets or sets whether the rule is active

Gets or sets the minimum days supply in order for the rule to apply

Gets or sets the maximum days supply in order for the rule to apply

Gets or sets the minimum age of the member in order for the rule to apply

Gets or sets the maximum age of the member in order for the rule to apply

Gets or sets the age units.

Gets or sets the dependent relationship code as a delimited list for which the rule applies.

Gets or sets the service category

Gets or sets the gender (if necessary) for which the rule applies

Gets or sets the list of acceptable pharmacy types

Gets or sets the rule's submission clarification code match criteria if applicable (possible values: Blank, Match, n/a)

Gets or sets the submission clarification codes for which the rule applies (This list is only used if SubmissionClarificationCodeCriteriaType is set to match)

Gets or sets the pharmacy service criteria type

Gets or sets the pharmacy service value. Uses standarded NCPDP values.

Gets or sets the patient residence criteria type

Gets or sets the patient residence value. Uses standarded NCPDP values.

Gets or sets the place of service criteria type

Gets or sets the place of service value. Uses standarded NCPDP values.

Gets or sets the Benefit Code Url

Gets or sets the Benefit Code number

Gets or sets the Prior Fills GPI Chars

Gets or sets the rule's submission clarification code match criteria if applicable (possible values: Blank, Match, n/a)

Gets or sets the acceptable DAW code values that apply to the rule

Gets or sets the list of contract codes associated with the general criteria

Gets or sets the list of AR codes associated with the general criteria

Gets or sets the coverage levels associated with the general criteria

Gets or sets the list of employee statuses associated with the general criteria

Gets or sets the list of other statuses associated with the general criteria

Gets or sets the list of US States associated with the general criteria

Gets or sets whether the rule is a template

Gets or sets the flag if this rule is overridden

Gets or sets the rule template thats being overridden

Gets or sets the rule template is enabled

Gets or sets the link representing a link back to the resource

Gets or sets the identifier for the resource