Universal API Implementation Guide
1.1.19 - ci-build
Universal API Implementation Guide - Local Development build (v1.1.19). See the Directory of published versions
When submitting a Co-Pay enrollment, our Co-pay administrators have established set values for specific fields that help facilitate the processing of enrollments.
The enroll-by-id field identifies who is applying for Co-pay assistance:
| Expected Value | Who is applying |
|---|---|
| 1 | Patient |
| 2 | Legally Authorized Person on behalf of the patient (LAP) |
| 4 | HCP on behalf of patient |
| 6 | HCP on behalf of LAP |
| 8 | Specialty Pharmacy |
| 10 | Specialty Pharmacy on behalf of LAP |
There are two types of assistance a patient can enroll into. A patient can be enrolled in one or both types of assistance programs.
NOTE: Not all brands offer both types of copay assistance.
| Product | Drug Copay Offered | Admin Copay Offered |
|---|---|---|
| Actemra | Yes | No |
| Alecensa | Yes | No |
| Avastin | Yes | No |
| Cotellic | Yes | No |
| Enspryng | Yes | No |
| Erivedge | Yes | No |
| Esbriet | Yes | No |
| Evrysdi | Yes | No |
| Gavreto | Yes | No |
| Gazyva | Yes | No |
| Herceptin | Yes | No |
| Herceptin Hylecta | Yes | No |
| Kadcyla | Yes | No |
| Lucentis | Yes | Yes |
| Lunsumio | Yes | No |
| Ocrevus | Yes | Yes |
| Perjeta | Yes | No |
| Phesgo | Yes | No |
| Polivy | Yes | No |
| Pulmozyme | Yes | No |
| Rituxan Hycela | Yes | No |
| Rituxan for Immunology | Yes | Yes |
| Rituxan for Oncology | Yes | No |
| Rozlytrek | Yes | No |
| Susvimo | Yes | Yes |
| Tecentriq | Yes | No |
| Vabysmo | Yes | Yes |
| Venclexta | Yes | No |
| Xolair | Yes | Yes |
| Zelboraf | Yes | No |
The Brand Id is a required field that identifies the product and the type(s) of assistance the patient is applying for. Multiple Brand Ids can be included in the FHIR bundle when (1) a patient requests to be enrolled in both the drug and admin copay programs and (2) a patient enrolls for a combo therapy.
| Program | Brand | Brand Id (Production) | Brand Id (UAT) |
|---|---|---|---|
| BioOncology | Alecensa | 18a1ea34-8e8c-413e-9043-ccd4c25f1a63 | bfa7fafa-4c9e-444a-861d-2bbc8dd2b656 |
| BioOncology | Avastin | d1cdefa8-6140-409e-b519-872ea1db6b03 | b5a3b04b-74af-481f-99eb-36a532e7c7da |
| BioOncology | Columvi | f695fb8a-cb22-4a85-b76a-7976c134070b | 657e0528-e7b5-4969-b92f-8866487bd94e |
| BioOncology | Cotellic | c127a362-5d2e-4a8e-a552-1c606eaf58f7 | a5b1cc66-973e-42df-93a0-6140b3e47b6e |
| BioOncology | Erivedge | 179ec971-ebef-4d2c-b87f-7a83b29eeeb2 | 88adb957-3ccd-4ff2-8c89-1423462bc02b |
| BioOncology | Gavreto | f2f6fb66-dad9-462e-b281-92fa6124f9e0 | 864d902b-401b-4d37-9bce-aa80f65e5a2e |
| BioOncology | Gazyva | 9b4e490f-ffbe-4aa7-943f-ea621cb705d9 | 92418abc-9ff2-4c4e-9bcf-dce6b8f6e5e5 |
| BioOncology | Herceptin | a8279013-054a-4cc2-896b-d29adfec5972 | 0ca3a21d-9ffe-4549-a368-90276d8694ae |
| BioOncology | Herceptin Hylecta | a548efb3-267d-49e8-9e0e-41a35508e11d | 23f4df7a-9ac7-45cb-a84e-556afa5212c5 |
| BioOncology | Kadcyla | 1c4a475b-c10e-4974-888e-f996ec35c136 | 2e3f20bb-a26a-4a9f-b9a6-16054180866d |
| BioOncology | Lunsumio | d58545cf-ddc0-4535-8de7-5ea41b9059d3 | 39716479-0982-4d44-9964-9dfd5737416a |
| BioOncology | Perjeta | aa2f6a82-c04c-480d-ab6e-2bc79d806353 | aab2fa4b-d7d8-4668-87f7-25ec9e2c42ba |
| BioOncology | Phesgo | c1893d9a-bc5a-4b91-8885-b4a22a59b97d | d47df534-659c-4647-98ae-b490cc821ba9 |
| BioOncology | Polivy | 2195a20c-4cd6-47d2-8ff6-f458b89281f4 | dff24507-0774-493f-9a8f-6f3e0cdf78b5 |
| BioOncology | Rituxan Hycela | 31209b89-fa46-4541-8d59-88b662c564cb | 4af9d0d0-d9a1-4737-b7b2-839a7f0e31f4 |
| BioOncology | Rituxan for Oncology | e36cda77-1c22-467a-b5fd-18ceddb6b023 | c52cf8ac-e452-40de-9324-de9b70b74375 |
| BioOncology | Rozlytrek | edf443bc-5fca-404c-a7ca-dbee11a564e5 | 439d3453-447b-48c7-84c8-e2055042bc0d |
| BioOncology | Tecentriq | 29c08e19-e811-496f-9521-b10ebf18f197 | 4143da8c-7622-424b-b666-84af907ac69e |
| BioOncology | Venclexta | 8371a7ff-70c8-411f-9778-6eca47ce28c5 | d814ba03-8fc4-42fa-bb6e-b56132ccf63f |
| BioOncology | Zelboraf | eb8f18ce-a05d-4775-bf5a-1b97f0df8dae | be76c957-d967-443c-b1c4-eedc150e2c5c |
| Enspryng | Enspryng | 249f47a4-4f65-4d89-9308-26b2ac3b3aac | e9d400c1-4154-4c27-ad5e-edeb61c2e15b |
| Esbriet | Esbriet | acb694cf-5d5b-45ed-aab4-6e16cd27a1b5 | 2aa02623-061b-44e2-9212-0e6b54025ac3 |
| Evrysdi | Evrysdi | 80d33880-d5c3-4c04-b5fa-0e6b83becf99 | 6eaf95e3-3dc9-4b70-9441-a309809a217a |
| Hemlibra | Hemlibra | b0c68be7-42ab-476d-9a34-ecb98fee35f6 | e8d84bf8-25a8-11ee-be56-0242ac120002 |
| Ocrevus | Ocrevus Drug | 8699576a-3247-429a-9e46-31c00f50f1a0 | 9c2693fd-4eb2-4543-a26b-2c85a3450fe2 |
| Ocrevus | Ocrevus Admin | 2e340749-5d09-4615-b0cf-29cb13d30972 | b8d8f918-8f39-4bb7-9e0e-ef1f26cc6e55 |
| Ophthalmology | Susvimo | ab812753-0273-4214-9822-8174bee8e42d | 1d5a38ac-e536-4b91-8b7c-62dc9f2bd56e |
| Ophthalmology | Lucentis | f0b91ca8-6a86-49d4-acce-ed7ea2df4d58 | 477136f7-ac31-4c07-ad07-2e010cbb2863 |
| Ophthalmology | Vabysmo | 2f34dfb8-81ea-4ea5-9f8d-5cf96c7caa91 | bf2a4e22-6d86-4e6d-b8a9-76f26fae2748 |
| Ophthalmology | Ophthamology Admin | f3681b89-6efd-4362-905f-6304abbfd6b5 | 93d32d3c-3ca8-4eed-ac55-8f4a93f61bdc |
| Pulmozyme | Pulmozyme | 88e44ee7-b7a1-4aee-b8e3-a7aa139a4cdc | 2275909f-b67d-4e57-8224-bead5c55e046 |
| RA Copay | Actemra | ee50b16e-aa22-4770-a2be-48d924c0b76c | b8bc2c4f-3baa-456f-84af-13414a52da2e |
| RA Copay | Rituxan | a3f1b8c8-c98a-41cd-8811-d71f85007265 | 5fdfb6d6-cfc5-41ed-9d3c-ac317291a38d |
| RA Copay | Rituxan Admin | 78f24040-b5c4-46f9-8942-ef9027e41697 | 21045343-07f3-4794-ba31-cfcea77823f0 |
| Xolair | Xolair Drug | 8afd5584-e738-4b01-94d9-5a60d9a0cab0 | fcb9d344-25a8-11ee-be56-0242ac120002 |
| Xolair | Xolair Admin | ef990cca-d6c7-4ddf-b652-f347b8af61b4 | 150e4c80-25f0-11ee-be56-0242ac120002 |
If patient has commercial or private insurance, then Insurance Plan Type is required field. If patient’s plan is not listed, select ‘Other’ and provide plan type.
| Insurance Plan Type |
|---|
| CDHP Consumer-directed Health Plan |
| EPO Exclusive Provider Organization |
| FFS Fee for Service |
| HDHP High-deductible Health Plan |
| HMO Health Maintenance Organization |
| HRA Health Reimbursement Account |
| HSA Health Savings Account |
| Indemnity |
| POS Point of Service |
| PPO Preferred Provider Organization |
| Union |
| Other. If Other, provide plan type |
If patient has commercial or private insurance, then Insurance Company (payer) is a required field. If patient’s insurance company is not listed, select ‘Other’ and provide insurance name.
| Insurance Companies |
|---|
| Aetna |
| Alliance Health |
| Amerihealth |
| Anthem |
| Assurant |
| Blue Cross |
| Blue Shield |
| BCBS |
| Cigna |
| Cox Health |
| First Choice |
| Geisinger |
| Harvard Pilgrim |
| Healthnet |
| Humana |
| Kaiser |
| Medco |
| Medica |
| Medical Mutual |
| Optima |
| Preferred One |
| Providence |
| Select Health |
| United Healthcare (UHC) |
| United Medical Resources (UMR) |
| Other. If Other, provide insurance company name |