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io.github.builtforai/coverage-exception

by builtforai · remote · no sign-in to list tools · v1.0.0 · published by GitHub user builtforai

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

Changes · 2
CompareRegistry entry

2 tools: 2 change things.

Scanned Oct 21, 2026

No check matched anything in the tool definitions. No finding is not a safety guarantee. How the checks work.

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

Tools

Open a tool for its reasons and full description. Descriptions are the publisher's own words, shown as they are.

2 tools

Changes things 2Claude Code: ask
  • medicare_coverage_restriction_and_exceptionFor 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 …No findings

    Why it is in this group

    • Nothing in its name or description says what it does, so it is counted as a write.
    Description, as the server wrote it
    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.
  • medicare_part_d_out_of_pocket_capProject 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 compa…No findings

    Why it is in this group

    • Nothing in its name or description says what it does, so it is counted as a write.
    Description, as the server wrote it
    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.

This is not a safety rating, and no finding is not a safety guarantee. The groups and findings come from fixed checks of the tool definitions the server returned on the date shown, not from its code or what it does when called. How the checks work.

Install

Pinned to version 1.0.0. Values in angle brackets are yours to fill in.

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

Run in a terminal.

Claude Code permissions

Allow the reads, ask before a change, deny the deletes. Paste into .claude/settings.json.

.claude/settings.json
{
  "permissions": {
    "allow": [],
    "ask": [
      "mcp__coverage-exception__medicare_part_d_out_of_pocket_cap",
      "mcp__coverage-exception__medicare_coverage_restriction_and_exception"
    ],
    "deny": []
  }
}

Tools that only read are allowed, tools that change things ask first, tools that delete or cancel are denied. It assumes the server is installed as coverage-exception. Review it before you use it.