coverage-exception

io.github.builtforai/coverage-exceptionVersion 1.0.0

Why Medicare Part D restricts a drug, and the exception and appeal path to challenge it

Status

Responds156 msNov 14, 2026, 14:46 UTCAnswered our handshake without sign-in.

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Last checked: Nov 14, 2026, 14:46 UTC
Latency: 156 ms
Remotes responding: 1 of 1
Sign-in: No sign-in
Hosting: Hosted outside the EU (detected)
Registry data as of: Nov 14, 2026, 21:12 UTC

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Connect

Streamable HTTP

https://insurewith.ai/mcpResponds156 msNov 14, 2026, 14:46 UTC

No sign-in

Claude Code

claude mcp add --transport http coverage-exception https://insurewith.ai/mcp

Claude Desktop and claude.ai

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Settings > Connectors > Add custom connector
Name: coverage-exception
Remote MCP server URL: https://insurewith.ai/mcp

Cursor

{
  "mcpServers": {
    "coverage-exception": {
      "url": "https://insurewith.ai/mcp"
    }
  }
}

VS Code

code --add-mcp '{"name":"coverage-exception","type":"http","url":"https://insurewith.ai/mcp"}'

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Tools

2 tools

Tools of coverage-exception
	Description		Read-only	Idempotent	Open world
`medicare_coverage_restriction_and_exception`For a drug on Medicare Part D, name the coverage problem — covered, prior authorization, step therapy, quantity limit, or not on formulary — and give the exception and appeal path with the CMS-named levels of appeal, who must submit the request, and what to ask the plan and the prescriber. Returns per-plan flag counts across plans held. Plan-specific clinical criteria and appeal deadlines are NOT held and are never inferred; they are returned in an explicit "unavailable" block rather than guessed.	For a drug on Medicare Part D, name the coverage problem — covered, prior authorization, step therapy, quantity limit, or not on formulary — and give the exception and appeal path with the CMS-named levels of appeal, who must submit the request, and what to ask the plan and the prescriber. Returns per-plan flag counts across plans held. Plan-specific clinical criteria and appeal deadlines are NOT held and are never inferred; they are returned in an explicit "unavailable" block rather than guessed.	Not declared	Not declared	Not declared	Not declared
`medicare_part_d_out_of_pocket_cap`Project month-by-month Medicare Part D out-of-pocket spending against the statutory annual cap, identify the month the cap is reached, quantify what the cap itself saves, and compare normal payment timing against the Medicare Prescription Payment Plan — which spreads the SAME total across the year without reducing it. Supports plan years 2026 and 2027 and fails closed to 2026 for any unsupported year rather than extrapolating. This is a standard-benefit simulation, NOT a plan-specific pharmacy quote: plan negotiated prices and plan cost sharing are not held and are never inferred.	Project month-by-month Medicare Part D out-of-pocket spending against the statutory annual cap, identify the month the cap is reached, quantify what the cap itself saves, and compare normal payment timing against the Medicare Prescription Payment Plan — which spreads the SAME total across the year without reducing it. Supports plan years 2026 and 2027 and fails closed to 2026 for any unsupported year rather than extrapolating. This is a standard-benefit simulation, NOT a plan-specific pharmacy quote: plan negotiated prices and plan cost sharing are not held and are never inferred.	Not declared	Not declared	Not declared	Not declared

Details

Registry status: Active
Published: Sep 18, 2026
Updated: Sep 18, 2026
Website: https://insurewith.ai/⁠ (opens in a new tab)
Repository: https://github.com/builtforai/builtforai-healthcare⁠ (opens in a new tab)
Categories: Uncategorized
GDPR: Not declared

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