specification: API Commons Plans
specificationVersion: '0.1'
schema: https://raw.githubusercontent.com/api-evangelist/interface-research/main/schema/api-commons.yml#/$defs/Plans
provider: Cigna
providerId: cigna
created: '2026-05-04'
# Provenance stamped 2026-08-11: this artifact was written by the API Evangelist
# bulk sweep dated 2026-05-04, not harvested from the provider. See roadmap#35.
method: generated
modified: '2026-05-05'
reconciled: false
tags:
  - CMS Interoperability
  - FHIR
  - Health Insurance
  - Healthcare
  - Patient Access
  - Provider Directory
  - SMART on FHIR
description: Cigna's developer APIs (Patient Access, Provider Directory, Drug Formulary, Provider
  Access) are CMS-mandated FHIR endpoints published under the CMS Interoperability and Patient Access
  final rule (and the Interoperability and Prior Authorization rule). They are not commercial APIs
  and have no published price — third-party applications register via SMART on FHIR / OAuth and
  consume them at no charge to comply with member-authorized data access. Provider Directory and
  Drug Formulary are public FHIR endpoints that do not require authentication for read access.
notes: No commercial pricing exists. Access is governed by federal interoperability rules, not a
  commercial plan.
sources:
  - https://developer.cigna.com/
  - https://developer.cigna.com/docs/service-apis
  - https://developer.cigna.com/docs/service-apis/patient-access/implementation-guide
plans:
  - id: cigna-public-fhir
    name: Public FHIR (Provider Directory and Drug Formulary)
    type: freemium
    description: Public, unauthenticated FHIR R4 endpoints for the Cigna Provider Directory and Drug
      Formulary APIs, conforming to the HL7 Da Vinci PDex Plan Network and US Drug Formulary
      implementation guides.
    entries:
      - label: API access
        name: api_access
        type: flat
        metric: request
        limit: -1
        timeFrame: usage
        geo: US
        unit: 1
        price: '$0 — public access'
        userMultiplied: false
    elements:
      - name: FHIR R4 conformance
      - name: Da Vinci PDex Plan Network IG
      - name: Da Vinci PDex US Drug Formulary IG
      - name: No authentication required
  - id: cigna-patient-access
    name: Patient Access (SMART on FHIR)
    type: freemium
    description: Member-authorized access to a Cigna member's claims, encounters, clinical data,
      coverage, and pharmacy information via SMART on FHIR / OAuth 2.0. Conforms to the CMS Patient
      Access rule and the HL7 Da Vinci PDex IG. Third-party application onboarding is required.
    entries:
      - label: API access
        name: api_access
        type: flat
        metric: request
        limit: -1
        timeFrame: usage
        geo: US
        unit: 1
        price: '$0 — CMS-mandated, member-authorized'
        userMultiplied: false
      - label: Application registration
        name: app_registration
        type: flat
        metric: usage
        limit: -1
        timeFrame: usage
        geo: US
        unit: 1
        price: '$0'
        userMultiplied: false
    elements:
      - name: SMART on FHIR / OAuth 2.0
      - name: Da Vinci PDex implementation guide
      - name: CMS Interoperability and Patient Access rule conformance
      - name: Application onboarding via the Cigna developer portal
  - id: cigna-provider-access
    name: Provider Access
    type: freemium
    description: Provider-authorized FHIR API for in-network providers to retrieve member clinical
      and claims data for care coordination. Conforms to the Da Vinci PDex Provider Access IG and
      the CMS Interoperability and Prior Authorization final rule.
    entries:
      - label: API access
        name: api_access
        type: flat
        metric: request
        limit: -1
        timeFrame: usage
        geo: US
        unit: 1
        price: '$0 — CMS-mandated, provider-authorized'
        userMultiplied: false
    elements:
      - name: FHIR R4 conformance
      - name: Da Vinci PDex Provider Access IG
      - name: Provider attestation / authorization workflow
maintainers:
  - FN: Kin Lane
    email: kin@apievangelist.com
x-canonical:
  generated: '2026-10-08'
  vocabulary: all/0-working/economics/plans-canonical.yml
  models:
  - subscription
  units:
  - none
  - request
  plans:
  - name: Public FHIR (Provider Directory and Drug Formulary)
    access: freemium
    model: subscription
    model_how: derived
    units:
    - request
    periods:
    - per-use
  - name: Patient Access (SMART on FHIR)
    access: freemium
    model: subscription
    model_how: derived
    units:
    - none
    - request
    periods:
    - per-use
  - name: Provider Access
    access: freemium
    model: subscription
    model_how: derived
    units:
    - request
    periods:
    - per-use