Coverage Exception

io.github.builtforaiPublished by GitHub account builtforaiv1.0.0Updated Oct 25, 2026

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

VerifiedStreamable HTTPWeb executableLocation & LifestyleFinance

Overview

AI-generated overview

A remote MCP server that helps an assistant explain Medicare Part D drug coverage restrictions and project out-of-pocket spending against the annual cap.

What you can do
Explain a Part D drug's coverage status, such as covered, prior authorization, step therapy, quantity limit, or not on formulary, and lay out the exception and appeal path with CMS-named appeal levels, who submits the request, and what to ask the plan and prescriber. Project month-by-month Part D out-of-pocket spending against the statutory annual cap, identify the month the cap is reached, quantify the cap's savings, and compare normal payment timing with the Medicare Prescription Payment Plan.
When to use it
Useful when someone asks why a Part D drug is restricted, how to request an exception or appeal a denial, or how their out-of-pocket costs will build up over the year and when they hit the cap.
Requirements
A remote streamable HTTP endpoint; no package, environment variables, or headers are declared. No authentication is declared.
Before you install
The tools return coverage and cost guidance, not a coverage decision; confirm details with the plan and prescriber. No credentials, payments, or data writes are shown in the input.

Installation

In SourceWeft

  1. Open Coverage Exception in the dashboard and add it to a workspace.
  2. Enable the server for the chats that should use its tools.

Web executable via Streamable HTTP. Remote servers run from the web runtime once configured in a workspace.

Use with an agent

Paste this prompt into Claude Code, Codex, Cursor or another agent — or into SourceWeft chat. The agent reads this server's install guide, shows you its publisher, endpoint and sign-in, and adds it to your client once you agree. Keys never go into a command.

Read https://sourceweft.com/mcp/io.github.builtforai%2Fcoverage-exception/install.md and connect the MCP server it describes to my client. Before changing any config, show me its publisher, endpoint and sign-in method and wait for my OK. Never put an API key in a command or in a file I would commit; ask me where it should come from.

Read the install guide the agent follows

Other MCP clients

Add this to your client's mcpServers config.

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

README

This repository has no README.

Tools

2

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.

Parametersdrugjoinyearmonthlyrequireddeductible

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.

Parametersdrugrequiredstate

Version history

1
  1. v1.0.0LatestSep 18, 2026

Score

75% of the applicable checks met

How complete this listing is, computed from the registry entry, the endpoint and public sources. Not a rating of the server and not a statement that it is safe or working today: reachability is a dated check, and no installs or reviews go into the score.

  • Reached in the last 30 daysRequired25 pts
  • Auth declaredRequired10 pts
  • Tools listedRequired15 pts
  • DescriptionRequired15 pts
  • Logo10 pts
  • Documentation15 pts

    Declare a GitHub repository with a README, or serve resource_documentation in the OAuth protected-resource metadata.

  • License10 pts

    Declare a license in the repository or the registry entry.