Medicare Part D: The Medicare prescription drug benefit program. We call this program “Part D” for short. Medicare Part D covers outpatient prescription drugs, vaccines, and some supplies not covered by Medicare Part A or Medicare Part B or Medical Assistance. Our plan includes Medicare Part D.Medicare Part A: The Medicare program that covers most medically necessary hospital, skilled nursing facility, home health, and hospice care.
Medicare Part B: The Medicare program that covers services (such as lab tests, surgeries, and doctor visits) and supplies (such as wheelchairs and walkers) that are medically necessary to treat a disease or condition. Medicare Part B also covers many preventive and screening services.Medical Assistance: This is the name of Minnesota’s Medicaid program. Medical Assistance is run by the state and is paid for by the state and the federal government. It helps people with limited incomes and resources pay for long-term services and supports and medical costs.
It covers extra services and some drugs not covered by Medicare. Medicaid programs vary from state to state, but most health care costs are covered if you qualify for both Medicare and Medicaid.

Technical Information

Machine-readable files

In accordance to Centers for Medicare & Medicaid Services (CMS) regulations, South Country Health Alliance is posting machine-readable JSON files for formulary data using the links below.

South Country Health Alliance has used all reasonable efforts to deliver accurate and current data as of the date noted in each file.

Note: These files are not intended for direct consumer use. South Country health plan members should refer to their plan materials and use online search tools to learn about their benefits, medications and providers.

NameLink
Medicaid FormularyMedicaid Formulary Sept 2024 (json)
Medicare Wrap Formulary for Medicare Advantage ProgramsMedicaid Wrap Formulary Sept 2024 (json)
Medicare FormularyMedicare Formulary Sept 2024 (json)

Provider Directory API

The Provider Directory API is publicly accessible and does not require any authorization to access the data. You can create an application to access data about providers and pharmacies using read-only RESTful API GET calls.

Base URL:
https://apis.ssctech.com/interop-scha/open/fhir/R4/

Provider Directory Resources
Supported Profiles:
HL7.FHIR.US.DAVINCI-PDEX-PLAN-NET\Profiles - FHIR v4.0.1
Da Vinci PlanNet Implementation Guide:
HL7.FHIR.US.DAVINCI-PDEX-PLAN-NET\Home - FHIR v4.0.1

Secure FHIR Resources

Member health care records and health plan records can be accessed via a secure Patient Access API. To request access to the Patient Access API, application developers must register their app. As part of the registration process, developers must complete and upload the Developer Access Questionnaire for Health Care Interoperability.

Once South Country Health Alliance has reviewed and approved access to the secure APIs, the developer will receive an email saying their access has been approved

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