> ## Documentation Index > Fetch the complete documentation index at: https://simplex.sh/docs/llms.txt > Use this file to discover all available pages before exploring further. # Get Clinical Questions > Returns the LOB-specific clinical question set required by the payer's policy for a given drug and diagnosis. ## OpenAPI ````yaml GET /get_clinical_questions openapi: 3.0.1 info: title: Simplex API description: API for browser automation, web scraping, and workflow automation license: name: MIT version: 1.0.0 servers: - url: https://api.simplex.sh security: - bearerAuth: [] paths: /get_clinical_questions: get: description: >- Returns the LOB-specific clinical question set required by the payer's policy for a given drug and diagnosis. parameters: - name: bin in: query required: true description: >- Pharmacy BIN from the patient's insurance card (e.g. "003858"). Required — drives LOB routing. schema: type: string - name: state in: query required: true description: >- Two-letter state code where the prescription will be filled (e.g. "CA"). Required — drives state-DOI mandated forms and state-Medicaid / MCO routing. schema: type: string - name: drug_name in: query required: true description: >- Drug brand or generic name. Required — drives which clinical schema is loaded. Matched case-insensitively on substring. schema: type: string enum: - wegovy - ozempic - zepbound - mounjaro - name: icd_code in: query required: true description: >- Exact ICD-10 diagnosis code (e.g. "E11.9"). Required — drives indication mapping and the specific question set returned. schema: type: string - name: pcn in: query required: false description: >- Processor Control Number from the patient's insurance card (e.g. "A4"). Optional — tiebreaks shared-BIN plans. schema: type: string - name: group_id in: query required: false description: >- NCPDP Group ID / group number from the patient's insurance card (e.g. "RXINN01"). Optional — tiebreaks when (BIN, PCN) hits multiple LOBs. schema: type: string - name: member_id in: query required: false description: >- Full member ID from the patient's insurance card (e.g. "4XS00000523646"). Optional — the resolver uses the leading alpha prefix to tiebreak shared-processor BINs where one (BIN, PCN) pair spans multiple lines of business (e.g. BIN 003858 / PCN A4 hosts ESI Commercial and Humana Part D). PHI: do not log the full value downstream. schema: type: string responses: '200': description: Get clinical questions response content: application/json: schema: $ref: '#/components/schemas/PaFaxGetClinicalQuestionsResponse' x-codeSamples: - lang: python label: Get clinical questions source: |- import requests url = 'https://api.simplex.sh/get_clinical_questions' headers = { 'X-API-Key': 'your_api_key_here' } params = { 'bin': '003858', 'state': 'CA', 'drug_name': 'wegovy', 'icd_code': 'E66.01', 'pcn': 'A4', 'member_id': '4XS00000523646' } response = requests.get(url, headers=headers, params=params) result = response.json() print(f"LOB: {result['lob_id']} ({result['coverage_status']})") if result['coverage_status'] == 'resolved': for q in result['questions']: print(f"{q['id']}: {q['prompt']} [{q['input_type']}]") if q.get('citation'): print(f" source: {q['citation']['policy_id']} § {q['citation']['section']}") for opt in q.get('options', []): print(f" - {opt}") - lang: curl label: Get clinical questions source: >- curl -X GET "https://api.simplex.sh/get_clinical_questions?bin=003858&state=CA&drug_name=wegovy&icd_code=E66.01&pcn=A4&member_id=4XS00000523646" \ -H "X-API-Key: your_api_key_here" components: schemas: PaFaxGetClinicalQuestionsResponse: type: object properties: matched: type: boolean description: Whether the (BIN, PCN, state) tuple resolved to a known payer. routing: type: object description: Payer routing resolved from the request identifiers. properties: pbm_name: type: string description: >- Pharmacy Benefit Manager name (e.g. "CVS Caremark", "Express Scripts"). line_of_business: type: string description: Line of business (e.g. "Aetna Commercial", "Humana Part D"). plan_name_or_group: type: string description: Plan / group name when distinguishable from LOB. confidence: type: string enum: - high - medium - low - none description: >- Routing confidence. `none` when the BIN/PCN pair did not match any known payer. drug: type: string description: The drug name echoed from the request. icd_code: type: string description: >- The ICD-10 code the questions were resolved for (echoed from the request). coverage_status: type: string enum: - resolved - ambiguous - not_covered - unknown_lob - not_attempted description: >- `resolved`: LOB identified, questions rendered. `ambiguous`: multiple LOBs match — supply more identifiers. `not_covered`: drug not covered by this LOB (see `rationale` — e.g. Part D statutory weight-loss exclusion). `unknown_lob`: drug has a schema but no matching LOB. `not_attempted`: `drug_name` didn't map to a drug with a clinical schema. lob_id: type: string description: >- Resolved line-of-business ID (e.g. "aetna_commercial_wegovy"). Null when `coverage_status` is not `resolved`. rationale: type: string description: >- Human-readable explanation of the resolution (which LOB won, or why one couldn't be chosen). questions: type: array description: >- Rendered clinical questions in presentation order. Empty when `coverage_status` is not `resolved`. items: $ref: '#/components/schemas/ClinicalQuestion' sources: type: array description: >- Upstream data sources consulted during resolution (payer sheets, CMS Part D, Availity, etc.). items: type: object properties: source_name: type: string source_url: type: string fetch_timestamp: type: string version: type: string required: - matched - coverage_status - icd_code - questions ClinicalQuestion: type: object description: >- A single question on the PA form, rendered from the LOB's clinical schema. Question order and presence are gated by `depends_on`. properties: id: type: string description: >- Stable question identifier — pass back as `question_id` in Fill Prior Authorization. prompt: type: string description: Question text as rendered to the reviewer. input_type: type: string enum: - boolean - numeric - date - text - select - multiselect - file_upload required: type: boolean description: Whether the question is required on the form. units: type: string description: For `numeric` questions, the expected unit (e.g. "kg/m²", "mg/dL"). options: type: array description: For `select` / `multiselect`, the allowed answer values. items: type: string depends_on: type: array description: >- Question IDs that gate this one — rendered only when those parent questions are answered affirmatively. items: type: string source: type: string description: >- Evidence markdown path the question was derived from (always populated). citation: allOf: - $ref: '#/components/schemas/ClinicalQuestionCitation' nullable: true description: >- Structured per-question citation back to the underlying payer policy. Present when the LOB has been backfilled with structured citations; `null` otherwise (the `source` path is still populated). required: - id - prompt - input_type ClinicalQuestionCitation: type: object description: Pointer back to the payer policy that justifies a clinical question. properties: policy_url: type: string description: Canonical policy URL on the payer's site. policy_id: type: string description: Payer policy identifier (e.g. "CPB 0345", "5.01.621"). section: type: string description: Section reference within the policy (e.g. "§A Eligibility 1.a"). quote: type: string description: Verbatim policy snippet this question encodes. effective_date: type: string description: Policy effective date (YYYY-MM-DD). evidence_path: type: string description: Relative path to the evidence markdown file (LOB-level fallback). securitySchemes: bearerAuth: type: apiKey in: header name: X-API-Key description: Simplex API Key ````