coverage-exception
Why Medicare Part D restricts a drug, and the exception and appeal path to challenge it
사용해야 할까요
품질 및 안전성
발견 사항 (2)
- LOWTool 'medicare_part_d_out_of_pocket_cap' name length outside 3-30 rangemedicare_part_d_out_of_pocket_cap에서
- LOWTool 'medicare_coverage_restriction_and_exception' name length outside 3-30 rangemedicare_coverage_restriction_and_exception에서
도구 정의와 프로토콜 준수에 대한 자동 분석을 기반으로 합니다.
컨텍스트 비용
이는 서버의 도구가 모델의 컨텍스트에 로드될 때마다 소비되는 대략적인 토큰 수입니다. 수치가 높을수록 다른 작업에 사용할 수 있는 주의가 줄어듭니다.
설치
원클릭 설치
`claude_desktop_config.json` 파일에 다음을 추가하세요:
{
"mcpServers": {
"coverage-exception": {
"url": "https://insurewith.ai/mcp"
}
}
}원격 엔드포인트
https://insurewith.ai/mcpstreamable-http할 수 있는 일
도구 목록
도구 (2)
⚪medicare_part_d_out_of_pocket_cap(monthly, drug, deductible, join, year)
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.
입력 스키마
{
"type": "object",
"properties": {
"monthly": {
"type": "string",
"description": "Expected monthly out-of-pocket spend on covered drugs, in USD, e.g. \"300\""
},
"drug": {
"type": "string",
"description": "Optional drug name — checks formulary status and whether spending on it counts toward the cap"
},
"deductible": {
"type": "string",
"description": "Optional plan drug deductible in USD, e.g. \"615\" or \"0\""
},
"join": {
"type": "string",
"description": "Optional month (1-12) the payment plan would be joined"
},
"year": {
"type": "string",
"description": "Optional plan year: 2026 or 2027"
}
},
"required": [
"monthly"
]
}🟡medicare_coverage_restriction_and_exception(drug, state)
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.
입력 스키마
{
"type": "object",
"properties": {
"drug": {
"type": "string",
"description": "Brand or generic drug name, e.g. \"Humira\", \"adalimumab\""
},
"state": {
"type": "string",
"description": "Optional 2-letter US state code, e.g. \"TX\""
}
},
"required": [
"drug"
]
}커뮤니티
증거