Terms of service

What this service is

Benefily reports what Medicare Part D plans have published in their own formularies as filed with the Centers for Medicare & Medicaid Services. It is an administrative reference tool.

What it is not

It is not medical advice, not legal advice, not a coverage or payment guarantee, and not an authorization. A determination describes what a plan has filed as of the effective date shown; it does not tell you whether a particular member has met the plan’s criteria, and it cannot substitute for confirming with the payer before rendering service.

Accuracy and limits

The underlying data is published monthly by CMS and can change. We publish the effective date and a SHA-256 of the exact file behind every answer so you can verify what we read. Where we hold no filing we report “unknown” — that is never a statement that prior authorization is unnecessary. You are responsible for verifying anything you rely on clinically or financially.

Acceptable use

Do not use the service to make or communicate a coverage decision without independent verification. Do not attempt to circumvent rate limits or entitlement checks. API keys are personal to your account; you are responsible for calls made with them.

Third-party material

Source data is a U.S. Government work in the public domain. Drug names come from RxNorm (U.S. National Library of Medicine). CPT® is a registered trademark of the American Medical Association; we do not reproduce CPT descriptors. We do not redistribute commercial payers’ medical prior-authorization lists — where relevant we link to the payer’s own document.

Liability

The service is provided “as is”, without warranty of any kind. To the maximum extent permitted by law, our aggregate liability is limited to the amount you paid in the twelve months preceding the claim.

Contact

support@benefily.com