coverage-exception

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

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What it can do

    What data it sees

    Do you need an account

    No: the server works without sign-in

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

    How to connect

    How to connect coverage-exception to Claude

    The server address to paste into Claude settings:

    https://insurewith.ai/mcp

    1. Open Claude (claude.ai or the desktop app).
    2. Go to Settings → Connectors.
    3. Click Add custom connector.
    4. Paste the server address copied below into Remote MCP server URL and click Add.
    5. In a chat, click + → Connectors and switch the new connector on.

    Custom connectors are available on Free, Pro, Max, Team and Enterprise plans (Free is limited to one). On Team and Enterprise an organization Owner adds the connector first under Organization settings → Connectors.

    Authorization

    After you click Add, a sign-in window for the service opens. Sign in with your own account and approve access. Claude never sees your password.

    How to connect coverage-exception to ChatGPT

    The server address to paste into ChatGPT settings:

    https://insurewith.ai/mcp

    1. Open ChatGPT in a browser (chatgpt.com). A Plus, Pro, Business, Enterprise or Edu plan is required.
    2. Turn on developer mode once: Settings → Apps → Advanced settings → Developer mode.
    3. Open Settings → Connectors and click Create.
    4. Fill in the form: Name (anything), Description (one line about what the service does), MCP server URL (copy it below).
    5. Under Authentication choose OAuth if the service requires sign-in, otherwise None. Click Create.
    6. In a new chat open + → Apps/Connectors and enable the connector.

    OpenAI has renamed this section before (Connectors → Apps/Plugins). If the label differs, search settings for "developer mode". On Business/Enterprise workspaces an admin must allow custom connectors first.

    Authorization

    On first use ChatGPT opens the service's sign-in window. Sign in and approve access.

    How to connect coverage-exception to Cursor

    The server address to paste into Cursor settings:

    https://insurewith.ai/mcp

    Fastest: click Open in Cursor below and confirm the prompt.

    Manually:

    1. In Cursor open Settings → Cursor Settings → MCP and click Add new global MCP server.
    2. Paste the JSON copied below into ~/.cursor/mcp.json (per project: .cursor/mcp.json in the repo root).
    3. Save the file. The server appears in the MCP list; authorize it there if asked.

    Authorization

    If the service needs sign-in, an authorize button appears next to the server in the MCP list.

    Server tool list (2)

    Raw names from tools/list. Only developers need these.

    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 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.
    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 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.