specification: API Commons Plans
specificationVersion: '0.1'
schema: https://raw.githubusercontent.com/api-evangelist/interface-research/main/schema/api-commons.yml#/$defs/Plans
provider: Humana
providerId: humana
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: true
tags:
  - FHIR
  - Health Insurance
  - Healthcare
  - Interoperability
  - CMS
description: Humana exposes FHIR R4-compliant APIs to satisfy CMS Patient Access (CMS-9115-F) and
  Provider Directory interoperability rules. The APIs are free of charge to registered third-party
  applications, with access governed by SMART on FHIR / OAuth 2.0, member consent, and CMS attestation
  requirements rather than commercial pricing tiers. There is no published list price, no metered
  rate card, and no tiered subscription. The Humana developer portal at developers.humana.com is
  scheduled to be retired and consuming applications will migrate to a successor portal.
notes: APIs are provided pursuant to CMS interoperability mandates; no commercial pricing exists.
  Plan entries describe the free regulatory access surface rather than dollar-denominated tiers.
sources:
  - https://developers.humana.com/
  - https://developers.humana.com/apis
  - https://www.cms.gov/regulations-and-guidance/guidance/interoperability/index
plans:
  - id: humana-developer-sandbox
    name: Developer Sandbox
    type: freemium
    description: Free, no-registration-required FHIR sandbox for testing against synthetic patient
      data and the Humana CapabilityStatement.
    entries:
      - label: Sandbox access
        name: sandbox_access
        type: flat
        metric: request
        limit: -1
        timeFrame: usage
        geo: US
        unit: 1
        price: '0.00'
        userMultiplied: false
    elements:
      - name: FHIR R4 sandbox endpoint
      - name: Synthetic patient data
      - name: CapabilityStatement
      - name: No registration required
  - id: humana-production-cms
    name: CMS Patient Access (Production)
    type: freemium
    description: Production access for third-party member-facing apps under CMS-9115-F. Requires
      developer registration, app attestation, and SMART on FHIR / OAuth 2.0 with member consent.
      No fees are charged to the application or member.
    entries:
      - label: Patient Access API requests
        name: patient_access_requests
        type: flat
        metric: request
        limit: -1
        timeFrame: usage
        geo: US
        unit: 1
        price: '0.00'
        userMultiplied: false
    elements:
      - name: SMART on FHIR / OAuth 2.0 member consent
      - name: AllergyIntolerance, CarePlan, CareTeam, Condition
      - name: Coverage, ExplanationOfBenefits
      - name: Goal, Immunization, Medication, Observation, Procedure
      - name: Required developer attestation
  - id: humana-provider-directory
    name: Provider Directory (Public)
    type: freemium
    description: CMS-mandated public Provider Directory FHIR API. No authentication required for
      provider directory queries.
    entries:
      - label: Provider Directory requests
        name: provider_directory_requests
        type: flat
        metric: request
        limit: -1
        timeFrame: usage
        geo: US
        unit: 1
        price: '0.00'
        userMultiplied: false
    elements:
      - name: Practitioner, PractitionerRole
      - name: Organization, Location
      - name: InsurancePlan
      - name: No authentication required
  - id: humana-drug-formulary
    name: Drug Formulary (Public)
    type: freemium
    description: CMS-mandated public Drug Formulary FHIR API listing covered medications and tier
      information.
    entries:
      - label: Formulary API requests
        name: formulary_requests
        type: flat
        metric: request
        limit: -1
        timeFrame: usage
        geo: US
        unit: 1
        price: '0.00'
        userMultiplied: false
    elements:
      - name: List, MedicationKnowledge resources
      - name: Drug formulary tiers
      - name: No authentication required
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:
  - request
  plans:
  - name: Developer Sandbox
    access: freemium
    model: subscription
    model_how: derived
    units:
    - request
    periods:
    - per-use
  - name: CMS Patient Access (Production)
    access: freemium
    model: subscription
    model_how: derived
    units:
    - request
    periods:
    - per-use
  - name: Provider Directory (Public)
    access: freemium
    model: subscription
    model_how: derived
    units:
    - request
    periods:
    - per-use
  - name: Drug Formulary (Public)
    access: freemium
    model: subscription
    model_how: derived
    units:
    - request
    periods:
    - per-use