GET/api/mmit/formulary

MMIT formulary coverage

Plan-by-plan formulary snapshot — tier, restrictions, lives covered.

Simulates MMIT Network formulary data. Returns 20+ real US payer plans (UHC, Anthem/Elevance, Aetna, Cigna, BCBS family, Humana, Centene, Kaiser, Molina) across commercial / Medicare Part D / Medicaid Managed Care / Health Exchange channels. Each plan carries both `drug_list_tier` (payer's raw tier) and `unified_tier` (MMIT-normalised) plus canonical restriction codes.

Query parameters

Name	Type	Description
`product`required	string	Brand name. e.g. `ZENVARA`
`as_of`	string (ISO date)	Snapshot date. Drives the month_id and the seeded sample. default: `today`

Response schema

Path	Type	Description
`product`	string	Echo of the product param.
`as_of`	string	Snapshot date in ISO.
`month_id`	integer	YYYYMM identifier for the snapshot — MMIT convention. Source: MMIT API monthid
`commercial_lives_covered_pct`	number	Lives-weighted commercial coverage percentage. Anchored to early-launch range 45-65%.
`medicare_lives_covered_pct`	number	Same for Medicare Part D. Range 30-50%.
`medicaid_lives_covered_pct`	number	Same for Medicaid Managed Care. Range 30-40%.
`plans[]`	array	Plan-level formulary entries.
`plans[].plan_id`	string	Stable plan identifier (e.g., PLN-UHC-COM-001).
`plans[].plan_name`	string	Real US payer plan name (e.g., 'UnitedHealthcare Choice Plus PPO').
`plans[].parent_payer`	string	Parent insurer (UnitedHealth Group, Elevance Health, etc.).
`plans[].pbm`	string	Pharmacy Benefit Manager (OptumRx, CVS Caremark, Express Scripts, etc.).
`plans[].controller`	string	Entity making the formulary decision — usually the PBM. Source: MMIT API
`plans[].channel`	enum	Commercial \| Medicare Part D \| Medicare Part B \| Medicaid Managed Care \| Health Exchange \| Managed Medicaid. Source: MMIT Analytics
`plans[].plan_type`	enum	HMO \| PPO \| EPO \| POS \| MA-PD \| PDP.
`plans[].benefit_design`	enum	Pharmacy or Medical.
`plans[].covered_lives_m`	number	Lives covered in millions. Anchored to Drug Channels / KFF / Venteur.
`plans[].drug_list_tier`	integer	Payer's raw tier (1-6). Tier nomenclature differs across payers.
`plans[].unified_tier`	enum	MMIT-normalised: Generic \| Preferred Brand \| Non-Preferred Brand \| Specialty \| Non-formulary \| Unknown. Source: MMIT FormularyUnifiedTiers
`plans[].coverage_status`	enum	Covered \| Covered with Restrictions \| Preferred \| Non-Preferred \| Not Covered \| Exception-Eligible \| Non-formulary \| Unknown. Source: MMIT glossary
`plans[].restrictions[]`	enum[]	PA (prior auth), ST (step therapy), QL (quantity limit), AL (age limit), GL (gender limit), BvD, LA (limited access / SP), MO (mail order), NF (non-formulary exception), SOC (site of care). Source: MMIT glossary + payer formulary keys
`plans[].effective_date`	string	When the plan's coverage decision took effect. ≤ as_of.
`plans[].as_of_date`	string	Snapshot observation date — equal to top-level as_of.
`summary`	object	Aggregations: total_plans, plans_covered, plans_not_covered, plans_with_pa, plans_with_st, plans_specialty_tier.

Behaviour notes

·20+ plans guaranteed, spanning commercial / Medicare / Medicaid / exchange.
·Commercial / Medicare coverage % anchored to realistic early-launch ranges.
·PA dominant restriction at launch (~72% of plans); ST and QL secondary.
·Top US payers (UHC, Aetna, Cigna, Humana, Anthem) always present.
·Two-date semantics: `as_of` = observation snapshot, `effective_date` = when the change took effect at the plan.

Examples

Coverage snapshot

curl 'http://localhost:3000/api/mmit/formulary?product=ZENVARA&as_of=2026-05-01'

Sources

MMIT Network API QuickStarthttps://api.mmitnetwork.com/Home/QuickStart
MMIT formulary coverage glossaryhttps://www.mmitnetwork.com/glossary/formulary-coverage/
MMIT FormularyUnifiedTiershttps://api.mmitnetwork.com/Resources/Index/Coverage?edgeName=FormularyUnifiedTiers
Drug Channels — Top PBMs 2025https://www.drugchannels.net/2026/03/the-top-pharmacy-benefit-managers-of.html

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