specification: API Commons Plans
specificationVersion: '0.1'
schema: https://raw.githubusercontent.com/api-evangelist/interface-research/main/schema/api-commons.yml#/$defs/Plans
provider: Independence Blue Cross
providerId: independence-blue-cross
created: '2026-05-23'
modified: '2026-05-23'
reconciled: true
tags:
  - FHIR
  - Healthcare
  - Health Insurance
  - Medicare Advantage
  - CHIP
  - Interoperability
  - CMS
  - Patient Access
  - Provider Directory
  - Drug Formulary
description: >-
  Independence Blue Cross exposes HL7 FHIR R4 APIs (Patient Access,
  Provider Directory, Drug Formulary) to satisfy the CMS
  Interoperability and Patient Access final rule (CMS-9115-F). API
  access is free to registered third-party applications: it is governed
  by SMART on FHIR / OAuth 2.0, member consent, and a CMS-aligned
  attestation rather than a commercial price tier. There is no list
  price, no metered rate card, and no paid subscription. Member
  health-plan products (commercial, Medicare Advantage, CHIP, dental,
  vision) are sold through employer brokers, the federal/PA
  Marketplace, CMS, and the Pennsylvania CHIP program and are out of
  scope for an API pricing surface.
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. Member-side
  insurance pricing (premiums, copays, deductibles) is set per
  product line and is not part of this API plans file.
sources:
  - https://devportal.ibx.com/
  - https://devportal.ibx.com/documentation/
  - https://www.ibx.com/developer-resources
  - https://www.ibx.com/scripts/custom/swagger/cmsSwagger.json
  - https://www.cms.gov/priorities/key-initiatives/burden-reduction/interoperability
plans:
  - id: ibx-developer-sandbox
    name: Developer Sandbox
    type: freemium
    description: >-
      Free sandbox access for testing against the IBX developer portal
      sandbox services. Sandbox member credentials are issued to
      registered developers after account activation.
    entries:
      - label: Sandbox FHIR requests
        name: sandbox_requests
        type: flat
        metric: request
        limit: -1
        timeFrame: usage
        geo: US
        unit: 1
        price: '0.00'
        userMultiplied: false
    elements:
      - name: FHIR R4 sandbox endpoints (Patient Access, Provider Directory, Drug Formulary)
      - name: Synthetic patient credentials issued to registered developers
      - name: Live CapabilityStatements for all three APIs
      - name: SMART App Launch / OAuth 2.0 / PKCE test flows
      - name: No commercial cost
  - id: ibx-production-patient-access
    name: CMS Patient Access (Production)
    type: freemium
    description: >-
      Production access for third-party member-facing apps under
      CMS-9115-F. Requires developer registration via
      https://devportal.ibx.com/cmssignin/, app attestation, and SMART
      on FHIR / OAuth 2.0 with member consent. In scope for
      Independence Medicare Advantage and Keystone HMO CHIP members.
      No fees are charged to the application or member.
    entries:
      - label: Patient Access FHIR requests
        name: patient_access_requests
        type: flat
        metric: request
        limit: -1
        timeFrame: usage
        geo: US
        unit: 1
        price: '0.00'
        userMultiplied: false
    elements:
      - name: Member-consented FHIR R4 read access
      - name: SMART App Launch 1.0.0 / OAuth 2.0 / PKCE
      - name: CARIN BB / Da Vinci PDex / US Core 3.1.1 conformance
      - name: No commercial price; access is regulatory-free
      - name: Member consent revocation honored at any time
  - id: ibx-production-provider-directory
    name: Provider Directory (Public)
    type: free
    description: >-
      Public Da Vinci PDex Plan-Net Provider Directory FHIR API. No
      authentication required; intended for member-facing apps,
      brokers, care navigation tools, and price/transparency apps.
    entries:
      - label: Provider Directory FHIR 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, Organization, OrganizationAffiliation
      - name: Location, HealthcareService, InsurancePlan, Endpoint
      - name: Da Vinci PDex Plan-Net IG conformance
      - name: Public; no authentication
  - id: ibx-production-formulary
    name: Drug Formulary (Public)
    type: free
    description: >-
      Public Da Vinci US Drug Formulary (USDF) FHIR API exposing the
      IBX covered drug list, tier information, and prior authorization
      indicators. No authentication required.
    entries:
      - label: Drug Formulary FHIR requests
        name: formulary_requests
        type: flat
        metric: request
        limit: -1
        timeFrame: usage
        geo: US
        unit: 1
        price: '0.00'
        userMultiplied: false
    elements:
      - name: MedicationKnowledge and List resources
      - name: Da Vinci USDF IG conformance
      - name: Public; no authentication
  - id: ibx-transparency-in-coverage
    name: Transparency In Coverage Machine-Readable Files
    type: free
    description: >-
      Monthly machine-readable JSON files of in-network rates, allowed
      amounts, and prescription drug pricing for three IBX-operated
      carrier brands (Keystone Health Plan East, QCC Insurance Company,
      Independence Assurance Co, Inc.). Public bulk download surface
      driven by the federal Transparency in Coverage rule.
    entries:
      - label: TiC file downloads
        name: tic_downloads
        type: flat
        metric: download
        limit: -1
        timeFrame: usage
        geo: US
        unit: 1
        price: '0.00'
        userMultiplied: false
    elements:
      - name: In-network negotiated rates per carrier brand
      - name: Out-of-network allowed amounts per carrier brand
      - name: Prescription drug pricing files
      - name: Monthly refresh cadence
      - name: Public; no authentication
maintainers:
  - FN: Kin Lane
    email: kin@apievangelist.com