# Medicare Formulary Change Tracker (`springstea/medicare-formulary-change-tracker`) Actor
Tracks Medicare Part D formulary changes for the drugs you care about: tier moves, prior authorization added or removed, step therapy, quantity limits, drugs dropped from formularies. Official CMS data, plan-level context, structured output.
- **URL**: https://apify.com/springstea/medicare-formulary-change-tracker.md
- **Developed by:** [Kasım Genç](https://apify.com/springstea) (community)
- **Categories:** Automation, Other
- **Stats:** 2 total users, 1 monthly users, 100.0% runs succeeded, 0 bookmarks
- **User rating**: No ratings yet
## Pricing
from $5.00 / 1,000 results
This Actor is paid per event. You are not charged for the Apify platform usage, but only a fixed price for specific events.
Learn more: https://docs.apify.com/platform/actors/running/actors-in-store#pay-per-event
## What's an Apify Actor?
Actors are a software tools running on the Apify platform, for all kinds of web data extraction and automation use cases.
In Batch mode, an Actor accepts a well-defined JSON input, performs an action which can take anything from a few seconds to a few hours,
and optionally produces a well-defined JSON output, datasets with results, or files in key-value store.
In Standby mode, an Actor provides a web server which can be used as a website, API, or an MCP server.
Actors are written with capital "A".
## How to integrate an Actor?
If asked about integration, you help developers integrate Actors into their projects.
You adapt to their stack and deliver integrations that are safe, well-documented, and production-ready.
The best way to integrate Actors is as follows.
In JavaScript/TypeScript projects, use official [JavaScript/TypeScript client](https://docs.apify.com/api/client/js/docs.md):
```bash
npm install apify-client
```
In Python projects, use official [Python client library](https://docs.apify.com/api/client/python/docs.md):
```bash
pip install apify-client
```
In shell scripts, use [Apify CLI](https://docs.apify.com/cli/docs.md):
````bash
# MacOS / Linux
curl -fsSL https://apify.com/install-cli.sh | bash
# Windows
irm https://apify.com/install-cli.ps1 | iex
```bash
In AI frameworks, you might use the [Apify MCP server](https://docs.apify.com/integrations/mcp.md).
If your project is in a different language, use the [REST API](https://docs.apify.com/api/v2.md).
For usage examples, see the [API](#api) section below.
For more details, see Apify documentation as [Markdown index](https://docs.apify.com/llms.txt) and [Markdown full-text](https://docs.apify.com/llms-full.txt).
# README
## Medicare Formulary Change Tracker
Tracks **Medicare Part D formulary changes** for the drugs you care about and reports every change as structured data:
- "Ozempic moved from Tier 2 to Tier 3 on this formulary (39 plans)." (`tier_changed`)
- "Prior authorization is now required." (`prior_auth_added`)
- "Step therapy added." / "Quantity limit changed from 2/28d to 1/28d."
- "The drug was dropped from this formulary entirely." (`drug_removed_from_formulary`)
**Source:** the official CMS *Monthly Prescription Drug Plan Formulary* files — the authoritative, complete record of every Part D formulary in the US, refreshed monthly. Drug names are resolved through the National Library of Medicine's RxNorm, so you can track by brand name ("Ozempic"), generic name ("semaglutide") or RXCUI — all dose forms are covered automatically.
### Who uses this
- **Pharma market-access teams** — know the day your product (or a competitor's) gets a tier bump, PA or ST anywhere in Part D.
- **Specialty pharmacies** — anticipate reimbursement friction before prescriptions start bouncing.
- **Benefit consultants & brokers** — advise clients with plan-level facts.
- **Healthcare analytics & investors** — formulary positioning changes as a clean data feed.
### How it works
Each run finds the newest CMS monthly release, extracts the formulary and plan-information files (a few MB via targeted range requests — not the full multi-GB archive), filters to your drugs' product RXCUIs, and diffs the coverage state of every (formulary × product) pair against the previous run's snapshot. Each change is enriched with plan context: how many plans use that formulary, sample plan names, contract ids and the states they operate in.
CMS publishes monthly — schedule the Actor **weekly or monthly**; runs between releases simply report zero changes.
### Input
```json
{
"drugs": ["Ozempic", "Eliquis", "Jardiance"],
"states": ["TX", "FL"],
"contractIds": [],
"emitBaselineRecords": false
}
````
| Field | Type | Description |
|---|---|---|
| `drugs` \* | `string[]` | Brand/generic names or RXCUIs, max 200. All product dose forms are tracked per drug. |
| `states` | `string[]` | Optional: only formularies used by plans operating in these states. |
| `contractIds` | `string[]` | Optional: only formularies used by these CMS contracts (e.g. `H0028`). |
| `emitBaselineRecords` | `boolean` | Push the full current coverage picture on the first run. A nationwide drug can span 500+ formularies × dose forms — thousands of records. Default `false`. |
| `snapshotStoreName` | `string` | Named key-value store for snapshots between runs. |
### Output
One dataset record per (formulary × drug product) change:
```json
{
"drug": "Eliquis",
"product": "apixaban 5 MG Oral Tablet [Eliquis]",
"rxcui": "1364445",
"formularyId": "00026000",
"planCount": 39,
"samplePlans": ["Humana Gold Plus SNP-DE H0028-007 (HMO D-SNP)"],
"contracts": ["H0028", "H1036"],
"states": ["FL", "GA", "NE", "TX"],
"changeType": "tier_changed",
"previousTier": 4,
"currentTier": 3,
"priorAuthorization": false,
"stepTherapy": false,
"quantityLimit": "2/28d",
"changes": [
{ "field": "tier", "kind": "tier_changed", "old": 4, "new": 3, "description": "Tier 4 -> 3 (more favorable)" }
],
"sourceFileDate": "20260630",
"detectedAt": "2026-07-10T18:08:50.965Z",
"source": "CMS Monthly Prescription Drug Plan Formulary (Medicare Part D)"
}
```
#### `changeType` values
| Value | Meaning |
|---|---|
| `baseline` | First run — current coverage state (opt-in). |
| `tier_changed` | Cost-sharing tier moved (see `previousTier`/`currentTier`). |
| `prior_auth_added` / `prior_auth_removed` | PA requirement toggled. |
| `step_therapy_added` / `step_therapy_removed` | ST requirement toggled. |
| `quantity_limit_added` / `quantity_limit_removed` / `quantity_limit_changed` | QL toggled or amount/days changed. |
| `drug_added_to_formulary` | Product newly covered by a formulary. |
| `drug_removed_from_formulary` | Product no longer on a formulary. |
A run summary (CMS release processed, counts per change type) is stored under the `OUTPUT` key of the default key-value store.
### Notes & limitations
- **Scope: Medicare Part D** (and MA-PD) formularies — the segment CMS publishes completely and machine-readably. Commercial/employer formularies are not included.
- Changes are detected at **formulary level** (CMS's unit of truth); the `planCount`/`contracts`/`states` fields tell you the blast radius of each change.
- The first run after the annual plan-year rollover (January file) naturally produces a large wave of changes — that's real (plans reset formularies yearly), not noise.
- This is data, not advice: verify critical decisions against the CMS files and plan documents.
# Actor input Schema
## `drugs` (type: `array`):
Brand or generic drug names (resolved via RxNorm, e.g. Ozempic, apixaban) or raw RxNorm RXCUIs. Max 200.
## `states` (type: `array`):
Optional. Only track formularies used by plans operating in these states (2-letter codes). Empty = nationwide.
## `contractIds` (type: `array`):
Optional. Only track formularies used by these CMS contract ids (e.g. H0028, S5884). Empty = all contracts.
## `emitBaselineRecords` (type: `boolean`):
On the first run there is nothing to compare against. When enabled, every (formulary × drug product) coverage state is pushed with changeType baseline. Caution: a nationwide drug can appear on 500+ formularies × several dose forms — thousands of records. Default off.
## `snapshotStoreName` (type: `string`):
Named key-value store keeping coverage snapshots between runs.
## `proxyConfiguration` (type: `object`):
Optional proxies (rarely needed — CMS and RxNorm are open APIs).
## Actor input object example
```json
{
"drugs": [
"Ozempic",
"Eliquis",
"Jardiance"
],
"states": [],
"contractIds": [],
"emitBaselineRecords": false,
"snapshotStoreName": "medicare-formulary-tracker"
}
```
# API
You can run this Actor programmatically using our API. Below are code examples in JavaScript, Python, and CLI, as well as the OpenAPI specification and MCP server setup.
## JavaScript example
```javascript
import { ApifyClient } from 'apify-client';
// Initialize the ApifyClient with your Apify API token
// Replace the '' with your token
const client = new ApifyClient({
token: '',
});
// Prepare Actor input
const input = {
"drugs": [
"Ozempic",
"Eliquis",
"Jardiance"
]
};
// Run the Actor and wait for it to finish
const run = await client.actor("springstea/medicare-formulary-change-tracker").call(input);
// Fetch and print Actor results from the run's dataset (if any)
console.log('Results from dataset');
console.log(`💾 Check your data here: https://console.apify.com/storage/datasets/${run.defaultDatasetId}`);
const { items } = await client.dataset(run.defaultDatasetId).listItems();
items.forEach((item) => {
console.dir(item);
});
// 📚 Want to learn more 📖? Go to → https://docs.apify.com/api/client/js/docs
```
## Python example
```python
from apify_client import ApifyClient
# Initialize the ApifyClient with your Apify API token
# Replace '' with your token.
client = ApifyClient("")
# Prepare the Actor input
run_input = { "drugs": [
"Ozempic",
"Eliquis",
"Jardiance",
] }
# Run the Actor and wait for it to finish
run = client.actor("springstea/medicare-formulary-change-tracker").call(run_input=run_input)
# Fetch and print Actor results from the run's dataset (if there are any)
print("💾 Check your data here: https://console.apify.com/storage/datasets/" + run["defaultDatasetId"])
for item in client.dataset(run["defaultDatasetId"]).iterate_items():
print(item)
# 📚 Want to learn more 📖? Go to → https://docs.apify.com/api/client/python/docs/quick-start
```
## CLI example
```bash
echo '{
"drugs": [
"Ozempic",
"Eliquis",
"Jardiance"
]
}' |
apify call springstea/medicare-formulary-change-tracker --silent --output-dataset
```
## MCP server setup
```json
{
"mcpServers": {
"apify": {
"command": "npx",
"args": [
"mcp-remote",
"https://mcp.apify.com/?tools=springstea/medicare-formulary-change-tracker",
"--header",
"Authorization: Bearer "
]
}
}
}
```
## OpenAPI specification
```json
{
"openapi": "3.0.1",
"info": {
"title": "Medicare Formulary Change Tracker",
"description": "Tracks Medicare Part D formulary changes for the drugs you care about: tier moves, prior authorization added or removed, step therapy, quantity limits, drugs dropped from formularies. Official CMS data, plan-level context, structured output.",
"version": "0.1",
"x-build-id": "NqZNiBOSKp3OuN0SV"
},
"servers": [
{
"url": "https://api.apify.com/v2"
}
],
"paths": {
"/acts/springstea~medicare-formulary-change-tracker/run-sync-get-dataset-items": {
"post": {
"operationId": "run-sync-get-dataset-items-springstea-medicare-formulary-change-tracker",
"x-openai-isConsequential": false,
"summary": "Executes an Actor, waits for its completion, and returns Actor's dataset items in response.",
"tags": [
"Run Actor"
],
"requestBody": {
"required": true,
"content": {
"application/json": {
"schema": {
"$ref": "#/components/schemas/inputSchema"
}
}
}
},
"parameters": [
{
"name": "token",
"in": "query",
"required": true,
"schema": {
"type": "string"
},
"description": "Enter your Apify token here"
}
],
"responses": {
"200": {
"description": "OK"
}
}
}
},
"/acts/springstea~medicare-formulary-change-tracker/runs": {
"post": {
"operationId": "runs-sync-springstea-medicare-formulary-change-tracker",
"x-openai-isConsequential": false,
"summary": "Executes an Actor and returns information about the initiated run in response.",
"tags": [
"Run Actor"
],
"requestBody": {
"required": true,
"content": {
"application/json": {
"schema": {
"$ref": "#/components/schemas/inputSchema"
}
}
}
},
"parameters": [
{
"name": "token",
"in": "query",
"required": true,
"schema": {
"type": "string"
},
"description": "Enter your Apify token here"
}
],
"responses": {
"200": {
"description": "OK",
"content": {
"application/json": {
"schema": {
"$ref": "#/components/schemas/runsResponseSchema"
}
}
}
}
}
}
},
"/acts/springstea~medicare-formulary-change-tracker/run-sync": {
"post": {
"operationId": "run-sync-springstea-medicare-formulary-change-tracker",
"x-openai-isConsequential": false,
"summary": "Executes an Actor, waits for completion, and returns the OUTPUT from Key-value store in response.",
"tags": [
"Run Actor"
],
"requestBody": {
"required": true,
"content": {
"application/json": {
"schema": {
"$ref": "#/components/schemas/inputSchema"
}
}
}
},
"parameters": [
{
"name": "token",
"in": "query",
"required": true,
"schema": {
"type": "string"
},
"description": "Enter your Apify token here"
}
],
"responses": {
"200": {
"description": "OK"
}
}
}
}
},
"components": {
"schemas": {
"inputSchema": {
"type": "object",
"required": [
"drugs"
],
"properties": {
"drugs": {
"title": "Drugs to track",
"type": "array",
"description": "Brand or generic drug names (resolved via RxNorm, e.g. Ozempic, apixaban) or raw RxNorm RXCUIs. Max 200.",
"items": {
"type": "string"
}
},
"states": {
"title": "State filter",
"type": "array",
"description": "Optional. Only track formularies used by plans operating in these states (2-letter codes). Empty = nationwide.",
"default": [],
"items": {
"type": "string"
}
},
"contractIds": {
"title": "Contract filter",
"type": "array",
"description": "Optional. Only track formularies used by these CMS contract ids (e.g. H0028, S5884). Empty = all contracts.",
"default": [],
"items": {
"type": "string"
}
},
"emitBaselineRecords": {
"title": "Emit baseline records on first run",
"type": "boolean",
"description": "On the first run there is nothing to compare against. When enabled, every (formulary × drug product) coverage state is pushed with changeType baseline. Caution: a nationwide drug can appear on 500+ formularies × several dose forms — thousands of records. Default off.",
"default": false
},
"snapshotStoreName": {
"title": "Snapshot store name",
"type": "string",
"description": "Named key-value store keeping coverage snapshots between runs.",
"default": "medicare-formulary-tracker"
},
"proxyConfiguration": {
"title": "Proxy configuration",
"type": "object",
"description": "Optional proxies (rarely needed — CMS and RxNorm are open APIs)."
}
}
},
"runsResponseSchema": {
"type": "object",
"properties": {
"data": {
"type": "object",
"properties": {
"id": {
"type": "string"
},
"actId": {
"type": "string"
},
"userId": {
"type": "string"
},
"startedAt": {
"type": "string",
"format": "date-time",
"example": "2025-01-08T00:00:00.000Z"
},
"finishedAt": {
"type": "string",
"format": "date-time",
"example": "2025-01-08T00:00:00.000Z"
},
"status": {
"type": "string",
"example": "READY"
},
"meta": {
"type": "object",
"properties": {
"origin": {
"type": "string",
"example": "API"
},
"userAgent": {
"type": "string"
}
}
},
"stats": {
"type": "object",
"properties": {
"inputBodyLen": {
"type": "integer",
"example": 2000
},
"rebootCount": {
"type": "integer",
"example": 0
},
"restartCount": {
"type": "integer",
"example": 0
},
"resurrectCount": {
"type": "integer",
"example": 0
},
"computeUnits": {
"type": "integer",
"example": 0
}
}
},
"options": {
"type": "object",
"properties": {
"build": {
"type": "string",
"example": "latest"
},
"timeoutSecs": {
"type": "integer",
"example": 300
},
"memoryMbytes": {
"type": "integer",
"example": 1024
},
"diskMbytes": {
"type": "integer",
"example": 2048
}
}
},
"buildId": {
"type": "string"
},
"defaultKeyValueStoreId": {
"type": "string"
},
"defaultDatasetId": {
"type": "string"
},
"defaultRequestQueueId": {
"type": "string"
},
"buildNumber": {
"type": "string",
"example": "1.0.0"
},
"containerUrl": {
"type": "string"
},
"usage": {
"type": "object",
"properties": {
"ACTOR_COMPUTE_UNITS": {
"type": "integer",
"example": 0
},
"DATASET_READS": {
"type": "integer",
"example": 0
},
"DATASET_WRITES": {
"type": "integer",
"example": 0
},
"KEY_VALUE_STORE_READS": {
"type": "integer",
"example": 0
},
"KEY_VALUE_STORE_WRITES": {
"type": "integer",
"example": 1
},
"KEY_VALUE_STORE_LISTS": {
"type": "integer",
"example": 0
},
"REQUEST_QUEUE_READS": {
"type": "integer",
"example": 0
},
"REQUEST_QUEUE_WRITES": {
"type": "integer",
"example": 0
},
"DATA_TRANSFER_INTERNAL_GBYTES": {
"type": "integer",
"example": 0
},
"DATA_TRANSFER_EXTERNAL_GBYTES": {
"type": "integer",
"example": 0
},
"PROXY_RESIDENTIAL_TRANSFER_GBYTES": {
"type": "integer",
"example": 0
},
"PROXY_SERPS": {
"type": "integer",
"example": 0
}
}
},
"usageTotalUsd": {
"type": "number",
"example": 0.00005
},
"usageUsd": {
"type": "object",
"properties": {
"ACTOR_COMPUTE_UNITS": {
"type": "integer",
"example": 0
},
"DATASET_READS": {
"type": "integer",
"example": 0
},
"DATASET_WRITES": {
"type": "integer",
"example": 0
},
"KEY_VALUE_STORE_READS": {
"type": "integer",
"example": 0
},
"KEY_VALUE_STORE_WRITES": {
"type": "number",
"example": 0.00005
},
"KEY_VALUE_STORE_LISTS": {
"type": "integer",
"example": 0
},
"REQUEST_QUEUE_READS": {
"type": "integer",
"example": 0
},
"REQUEST_QUEUE_WRITES": {
"type": "integer",
"example": 0
},
"DATA_TRANSFER_INTERNAL_GBYTES": {
"type": "integer",
"example": 0
},
"DATA_TRANSFER_EXTERNAL_GBYTES": {
"type": "integer",
"example": 0
},
"PROXY_RESIDENTIAL_TRANSFER_GBYTES": {
"type": "integer",
"example": 0
},
"PROXY_SERPS": {
"type": "integer",
"example": 0
}
}
}
}
}
}
}
}
}
}
```