{"uid":"cap_7O3fkJKL2kw1JbRi9E5R9","slug":"medicare-part-d-plan-cost-coverage-lookup-e32f9a4b","name":"Medicare Part D Plan Cost & Coverage Lookup","description":"What does this Medicare Part D plan cost and cover? Premium, deductible, service area, cost sharing by tier and one drug’s terms for a contract-plan-segment id, computed by Distill from CMS’s monthly formulary files. Updated monthly. $0.01 per call (x402, USDC on Base); 3 free calls a day.","url":"https://data.spencermcw.com/v1/medicare/partd/plan?utm_source=zero.xyz","method":"GET","headers":{},"bodySchema":{"type":"object","$schema":"https://json-schema.org/draft/2020-12/schema","required":["input"],"properties":{"input":{"type":"object","required":["type","method"],"properties":{"type":{"type":"string","const":"http"},"method":{"enum":["GET"],"type":"string"},"queryParams":{"type":"object","required":["plan"],"properties":{"ndc":{"type":"string","pattern":"^\\d{11}$"},"plan":{"type":"string","pattern":"^[A-Za-z]\\d{4}-\\d{3}-\\d{3}$"},"rxcui":{"type":"string","pattern":"^\\d{1,10}$"},"plan_year":{"type":"integer","maximum":2100,"minimum":2000}}}},"additionalProperties":false},"output":{"type":"object","required":["type"],"properties":{"type":{"type":"string"},"example":{"type":"object","properties":{"data":{"type":"object","required":["plan_year","file_date","plan","plan_name","contract_name","kind","snp","formulary_id","premium","deductible","service_area","tiers","drug"],"properties":{"snp":{"type":["string","null"]},"drug":{"anyOf":[{"anyOf":[{"type":"object","required":["rxcui","covered","tier","prior_authorization","step_therapy","quantity_limit","negotiated_drug","terms_vary_by_ndc"],"properties":{"tier":{"type":"integer","maximum":9007199254740991,"minimum":-9007199254740991},"rxcui":{"type":"string"},"covered":{"type":"boolean","const":true},"step_therapy":{"type":"boolean"},"quantity_limit":{"anyOf":[{"type":"object"},{"type":"null"}]},"negotiated_drug":{"type":"boolean"},"terms_vary_by_ndc":{"type":"boolean"},"prior_authorization":{"type":"boolean"}},"additionalProperties":false},{"type":"object","required":["rxcui","covered"],"properties":{"rxcui":{"type":"string"},"covered":{"type":"boolean","const":false}},"additionalProperties":false}]},{"type":"null"}]},"kind":{"type":"string"},"plan":{"type":"string"},"tiers":{"type":"array","items":{"type":"object","required":["tier","specialty","deductible_applies","preferred_retail","standard_retail","preferred_mail","standard_mail"],"properties":{"tier":{"type":"integer","maximum":9007199254740991,"minimum":-9007199254740991},"specialty":{"type":"boolean"},"standard_mail":{"type":"object"},"preferred_mail":{"type":"object"},"standard_retail":{"type":"object"},"preferred_retail":{"type":"object"},"deductible_applies":{"type":"boolean"}},"additionalProperties":false}},"premium":{"type":["string","null"]},"file_date":{"type":"string"},"plan_name":{"type":"string"},"plan_year":{"type":"integer","maximum":9007199254740991,"minimum":-9007199254740991},"deductible":{"type":["string","null"]},"formulary_id":{"type":"string"},"service_area":{"type":"object","required":["counties","ma_regions","pdp_regions"],"properties":{"counties":{"type":"integer","maximum":9007199254740991,"minimum":-9007199254740991},"ma_regions":{"type":"array"},"pdp_regions":{"type":"array"}},"additionalProperties":false},"contract_name":{"type":"string"}},"additionalProperties":false}}}}}}},"responseSchema":null,"example":null,"exampleRequest":null,"tags":["x402"],"displayCostAmount":"0.01","displayCostAsset":"USDC","priceDynamic":false,"priceHint":null,"priceStatus":"priced","priceSource":"probe","requiresHandshake":false,"reviewCount":0,"rating":{"score":"0.00","successRate":"0.00","reviews":0,"stars":null,"state":"unrated"},"availabilityStatus":"unknown","priceObserved":null,"sessionDeposit":null,"pricing":{"kind":"static","summary":"$0.01/call","primary":{"kind":"static","protocol":"x402","network":"base","amountUsd":"0.01","per":"call","confidence":"exact"},"accepted":[{"kind":"static","protocol":"x402","network":"base","amountUsd":"0.01","per":"call","confidence":"exact"}]},"paymentMethods":[{"uid":"pm_fvfwozd5vI6_ncZFCMFs0","protocol":"x402","methodType":"crypto","chain":"base","mode":"charge","costAmount":"0.01","costPer":"request","priority":0,"asset":"0x833589fCD6eDb6E08f4c7C32D4f71b54bdA02913","unit":"request","depositMicros":null,"planRef":null}],"brandName":null,"brandSlug":null,"brandBaseUrl":null,"brandDocsUrl":null,"whatItDoes":"Returns premium, deductible, service area, tier cost-sharing, and one drug's formulary terms for a specific Medicare Part D contract-plan-segment.","exampleAgentPrompt":"What does Medicare Part D plan H1234-001-000 cost for 2024, and is the drug with RxCUI 860975 covered — what tier is it on and does it require prior authorization?","exampleUseCases":[{"title":"Comparing Part D plan costs for enrollment","prompt":"I'm helping my mom pick a Medicare Part D plan for 2024. Can you pull up the premium, deductible, and tier cost-sharing details for plan H5521-003-000?"},{"title":"Checking drug coverage before switching plans","prompt":"My dad takes atorvastatin — RxCUI 83367 — and is on Medicare Part D plan S5820-019-000. Does that plan cover it, what tier is it on, and is prior auth required?"},{"title":"Benefits counselor verifying formulary terms","prompt":"I need the full formulary breakdown for Medicare Part D plan H2172-002-000 for plan year 2024, including whether drug NDC 00071015523 has any step therapy or quantity limit restrictions."}],"resultDescription":"A JSON object containing plan metadata (plan year, file date, plan ID, plan name, contract name, plan kind, SNP type, formulary ID), financial terms (premium, deductible), geographic service area, an array of tier cost-sharing structures (tier number, specialty flag, whether deductible applies, preferred/standard retail and mail-order costs), and optionally one drug's formulary terms (covered status, tier, prior authorization, step therapy, quantity limit, negotiated drug flag, terms-vary-by-NDC flag).","failureModes":["Invalid plan ID format returns validation error","Unknown plan ID returns empty or not-found response","NDC must be exactly 11 digits — malformed NDC returns error","RxCUI must be numeric and up to 10 digits","Drug not found in formulary returns covered: false","Plan year out of range (before 2000 or after 2100) returns validation error","Rate limit exceeded after 3 free daily calls without payment","Payment failure via x402/USDC returns 402 error"],"whenToPreferThis":"Use this endpoint when you need authoritative, CMS-sourced cost and coverage details for a specific Medicare Part D plan identified by its contract-plan-segment ID. Prefer this over general drug lookup endpoints when you need tier cost-sharing structures, premiums, deductibles, and service area together with a specific drug's formulary terms in one call. Best suited for benefits counseling, plan comparison tools, and eligibility/coverage verification workflows.","instructions":null,"reviewSummary":null,"reviewSummaryHighlights":null,"reviewSummaryConcerns":null,"reviewSummaryGeneratedAt":null,"activationCount":0,"lastUsedAt":null,"lastSuccessfullyRanAt":null,"lastHealthCheckAt":"2026-10-23T12:39:49.362Z","isFirstParty":false,"canonicalSlug":"medicare-part-d-plan-cost-coverage-lookup-e32f9a4b"}