1up Formulary | Accessible Drug Coverage Information

1up Formulary

Make drug coverage information easy to understand using a CMS-compliant, FHIR®-first formulary API.

Drug Coverage Clarity You Can Trust

Members and providers often face uncertainty regarding drug coverage, formulary alternatives, and costs, which can lead to confusion, delays, and unnecessary administrative burden. 1up Formulary simplifies access to drug coverage information through a public, CMS-compliant API.

The solution makes covered medications, alternatives, and pricing information easy to view within connected apps or portals.

Clear Coverage and Costs

Gives members and providers a clear view of covered drugs, tiers, restrictions, and alternatives to support informed treatment and enrollment decisions.

Lower Call Center Volume

Reduces confusion-driven calls by making it easy to access up-to-date formulary information across member- and provider-facing tools.

Better Medication Adherence

Helps members understand their options and costs upfront, supporting adherence and improving overall satisfaction with pharmacy benefits.

1upHealth delivers on their promise and helps us comply with CMS mandates across all different components.

CIO, December 2024, collected by KLAS Research

CMS Compliance Made Easy

Meet CMS-9115-F Formulary requirements with a fully managed solution, without needing to build or maintain APIs yourself.

Formulary FHIR API

Public-facing FHIR R4 API that requires no authorization and makes drug coverage, alternatives, and cost information easy to discover.

Formulary Usage Reporting

Pre-built dashboards that show how your public API is being used, including request volume, access patterns, and resource activity.

How It Works

A simple and CMS-compliant workflow for publishing and maintaining clear, accessible drug coverage information.

Formulary Data Ingestion

Formulary data is ingested from source systems, validated, and mapped into clean, standards-based FHIR resources per the Da Vinci US Drug Formulary Implementation Guide.

Formulary API Publication

1up publishes a public, CMS-9115-F-compliant Formulary API that applications and portals can use to display coverage and cost information.

Drug Coverage Discovery

CMS, Medicare.gov, member-facing tools, provider systems, and third-party applications use the API to show covered medications, alternatives, and pricing details.

Ongoing Updates

Ongoing synchronization ensures drug coverage updates are reflected within required timeframes and remain accessible to all.

FAQs

What data must be included?
All CMS-regulated payers must include covered drugs, tiers, utilization management requirements, and alternative options in their formulary data.

Cost-sharing details may vary by plan and line of business.

How often is formulary data updated?
Formulary data is updated within CMS-required timeframes after changes are received (within 30 days).

Does 1up Formulary support member and provider tools?
Yes. Standardized FHIR data allows formulary information to be embedded into member portals, provider systems, and third-party applications.

Additional Resources

Ready to Make Drug Coverage Easier to Understand?

Publish clear, accurate formulary information. Meet CMS-9115-F requirements. Improve member satisfaction with 1up Formulary.