Current Active Requests: Pricing

Price Request

Returns pricing information on a transaction for a member. Pricing Request bypasses common rejections that would occur in the adjudication flow to return pricing.

Sample Request / Parameters

/PricingRequest

A sample request is seen below.

Parameters are explained below:

FIELD	REQUIRED?	Additional Info
RequestId	OPTIONAL	Provide your own hexadecimal (a-f, 0-9) unique Request Identifier in format 00000000-0000-0000-0000-100000000000. This value does not have to be unique. If no value provided, or not in this format a RequestId will be automatically generated for the response.
Bin	REQUIRED	BIN used to adjudicate claims to the plan. Failure to submit this value at all will result in a null response.
Npi	REQUIRED	NPI for the pharmacy the claim is for. Failure to submit this value at all will result in a null response.
Pcn	OPTIONAL	Processor Control Number used to adjudicate claims to the plan. As not all plans utilize PCN values, not submitting this field is ok if Blank PCN works for program.
Group	OPTIONAL	Group number of the plan for adjudication. Depending on plan settings, other attributes such as Cardholder ID and date of birth may be enough to get the claim to the right patient.
Ndc	REQUIRED	Drug NDC for pricing.
Quantity	REQUIRED	Quantity of the drug
DaysSupply	REQUIRED	Days Supply of the drug
FirstName	REQUIRED	First name of the member pricing the claim. The usage of first name will vary based on plan settings.
LastName	REQUIRED	Last name of the member pricing the claim. The usage of last name will vary based on plan settings.
DOS	REQUIRED	Date of Service for the pricing. Formats of CCYY-MM-DD and MM/DD/CCYY are both acceptable
DOB	OPTIONAL	Patient Date of Birth. Individual Client plan settings may require this value be included. Formats of CCYY-MM-DD and MM/DD/CCYY are both acceptable
DateWritten	OPTIONAL	Date the prescription is written.
Gender	OPTIONAL	Gender of the patient. 1 = male, 2 = female, 3 = other
CHID	REQUIRED	Cardholder ID of the patient the pricing is for.
PersonCode	OPTIONAL	Person Code of Cardholder ID. Individual plan settings may require this value be included.
CompoundCode	OPTIONAL	Indicates if transaction is a compound or not. API is not able to price compounded claims, please either omit field entirely or send a “1” for not a compound.
RxNumber	OPTIONAL	The Prescription Number. Any number up to 12 in length can be used or the field omitted entirely.
DAW	OPTIONAL	The Dispense as Written code for the claim. This can be omitted entirely unless plan rules require it for brands with generics available.
OCC	OPTIONAL	Other Coverage Code. Only needed if plan requires a value, in which case send 0 or 1.
PrescriberNpi	OPTIONAL	NPI Number of the prescriber. Only needed if plan requires a value for it.
IngredientCost	OPTIONAL	Ingredient Cost for the product being dispensed as would be submitted by the pharmacy. Only needed if plan requires a value for it. When plans require a value, it is best to submit a high value for this field (999999.99) to make sure this value does not impact the pricing of the claim. Values above this may result in a null response from the API.
DispensingFee	OPTIONAL	Dispensing Fee for the product as it would be submitted by the pharmacy. Only needed if plan requires a value for it.
UsualAndCustomary	OPTIONAL	Usual and Customary price for the product as submitted by the pharmacy. Only needed if plan requires a value for it. When plans require a value, it is best to submit a high value for this field (999999.99) to make sure this value does not impact the pricing of the claim. Values above this may result in a null response from the API.
GrossAmountDue	OPTIONAL	Gross Amount Due for the product as submitted by the pharmacy. Only needed if plan requires a value for it. When plans require a value, it is best to submit a high value for this field (999999.99) to make sure this value does not impact the pricing of the claim. Values above this may result in a null response from the API.
IgnoreAccumulators	OPTIONAL	Send True (true, TRUE also acceptable) if you want to ignore the patients deductible, Max Out of Pocket, and Benefit Cap rules and just get a price for the claim. Send false or omit the field entirely if you want to include deductible and out of pocket in the determination.
JobRunId	OPTIONAL	For future expansion. Please send 0 or omit entirely.

curl --location --request POST 'https://clientapi.test.ad.rxlogic.com/PricingRequest' \
--header 'Content-Type: application/x-www-form-urlencoded' \
--header 'apiKey: 11111111-1111-1111-1111-111111111111' \
--data-urlencode 'RequestId=00000000-0000-0000-0000-100000000000' \
--data-urlencode 'Bin=000000' \
--data-urlencode 'Npi=1407113574' \
--data-urlencode 'Pcn=HD1' \
--data-urlencode 'Group=3934' \
--data-urlencode 'Ndc=61958180101' \
--data-urlencode 'Quantity=5' \
--data-urlencode 'DaysSupply=30' \
--data-urlencode 'FirstName=PHARM' \
--data-urlencode 'LastName=TESTER' \
--data-urlencode 'DOS=2021-08-18' \
--data-urlencode 'DOB=1980-04-30' \
--data-urlencode 'DateWritten=2021-08-18' \
--data-urlencode 'Gender=1' \
--data-urlencode 'CHID=3934MEMBER' \
--data-urlencode 'PersonCode=01' \
--data-urlencode 'CompoundCode=1' \
--data-urlencode 'RxNumber=202108199001' \
--data-urlencode 'DAW=0' \
--data-urlencode 'OCC=0' \
--data-urlencode 'PrescriberNpi=1942252895' \
--data-urlencode 'IngredientCost=999.99' \
--data-urlencode 'DispensingFee=0' \
--data-urlencode 'UsualAndCustomary=9999' \
--data-urlencode 'GrossAmountDue=9999' \
--data-urlencode 'IgnoreAccumulators=false' \
--data-urlencode 'JobRunId=0'
/* Enter your code */

Sample Response (Paid Transaction)

Response fields are explained below:

Field	Description
RequestId	The RequestId provided on the request, or a generated value identifying the transaction. This is not the RxLogic Transmission ID
Status	Response of the transaction. 1 = Paid, 3 = Rejected
Gpi	The GPI of the NDC provided
UnitCost	The per unit cost of the drug post adjustments made to calculate claim price.
DAWDifference	The cost difference between a brand with a generic available product and an equivalent generic.
PatientPay	The amount the patient will be responsible for at the pharmacy
TotalPay	The amount the pharmacy will be reimbursed for the transaction
PlanPay	The amount the plan will be billed for the transaction.
ProcessingFee	No current function. Included for future expansion.
DispensingFee	The sum of the buy and sell dispensing fees.
IncentiveFee	The incentive fee paid to the pharmacy for the transaction.
Copay	The amount the patient will pay at the pharmacy not including other fees.
ClientBilled	Amount the client will be billed for the transaction.
MarginApplied	Amount of margin markup on the claim.
FQMessage	Messaging returned to the pharmacy specific to the transaction. This may include informational messages on paid transactions.
F4Message	Messaging returned to the pharmacy. This is for transaction header level errors and will usually indicate a critical missing element from the transaction.
BenefitCap	The amount the patient will have accumulated to their Benefit Cap after this transaction.
Deductible	The amount the patient will have accumulated to their Deductible after this transaction.
MOOP	The amount the patient will have accumulated to the members Max Out of Pocket after this transaction.
PatientTax	Reserved for Future Use
SellTax	Tax amount billed to the plan
BuyTax	Tax amount paid to the pharmacy.
PharmacyFee	Additional fees charged to the pharmacy that would have reduced their payment.
VaccineAdminFee	Reserved for future use.
SellDispensingFee	The dispensing fee billed to the plan.
BuyDispensingFee	The dispensing fee paid to the pharmacy.
SellIngredientCost	Ingredient Cost billed to the client
BuyIngredientCost	Ingredient Cost paid to the pharmacy.
RejectCodes	A comma separated list of NCPDP reject codes that applied to the transaction.
BillCostCalculatorRuleName	The Bill Cost Calculator used to determine the sell side pricing.
CostCalculatorRuleName	The Cost Calculator used to determine the buy side pricing
CopayRuleName	The Copay Rule used to determine what the patient pays for the transaction.

{
    "RequestId": "00000000-0000-0000-0000-100000000000",
    "Status": 1,
    "Gpi": "12359902400320",
    "UnitCost": 1039.5000000000,
    "DAWDifference": null,
    "PatientPay": 0.00,
    "TotalPay": 5246.68,
    "PlanPay": 8149.18,
    "ProcessingFee": 0.0,
    "DispensingFee": null,
    "IncentiveFee": 0.0,
    "Copay": 0.00,
    "ClientBilled": 8149.18,
    "MarginApplied": 8151.17875000000000000,
    "FQMessage": "USED NETWORK MAC",
    "F4Message": null,
    "BenefitCap": 121.9000,
    "Deductible": 92.0000,
    "MOOP": 96.0000,
    "PatientTax": 0.0,
    "SellTax": 0.0,
    "BuyTax": 44.178750,
    "PharmacyFee": 0.0,
    "VaccineAdminFee": null,
    "SellDispensingFee": 5.00,
    "BuyDispensingFee": 5.00,
    "SellIngredientCost": 8149.17875000000000000,
    "BuyIngredientCost": 5197.50,
    "RejectCodes": "",
    "BillCostCalculatorRuleName": "ClonedNoPassTax",
    "CostCalculatorRuleName": "A77/A75/U/M",
    "CopayRuleName": "$0 Copay"
}
/* Enter your code */

Sample Response (Rejected Transaction)

{
    "RequestId": "00000000-0000-0000-0000-100000000000",
    "Status": 3,
    "Gpi": "12359902400320",
    "UnitCost": 0.0,
    "DAWDifference": null,
    "PatientPay": null,
    "TotalPay": null,
    "PlanPay": null,
    "ProcessingFee": null,
    "DispensingFee": null,
    "IncentiveFee": null,
    "Copay": null,
    "ClientBilled": null,
    "MarginApplied": null,
    "FQMessage": "PRODUCT/SERVICE NOT COVERED - PLAN/BENEFIT EXCLUSION (PHARMACY NOT IN CASH CARDNETWORK. )",
    "F4Message": null,
    "BenefitCap": null,
    "Deductible": null,
    "MOOP": null,
    "PatientTax": 0.0,
    "SellTax": null,
    "BuyTax": null,
    "PharmacyFee": null,
    "VaccineAdminFee": null,
    "SellDispensingFee": null,
    "BuyDispensingFee": null,
    "SellIngredientCost": null,
    "BuyIngredientCost": null,
    "RejectCodes": "70",
    "BillCostCalculatorRuleName": null,
    "CostCalculatorRuleName": null,
    "CopayRuleName": null
}
/* Enter your code */

Current Active Requests: Pricing

Welcome to the Pricing section of Current Active Requests. Below are options for Pricing. These sections will include descriptors of both, as well as sample requests/parameters for each. Click one of the options below to get started!

Price Request

Sample Response (Paid Transaction)

Sample Response (Rejected Transaction)