io.github.builtforai/coverage-exception
repo:https://github.com/builtforai/builtforai-healthcare
Why Medicare Part D restricts a drug, and the exception and appeal path to challenge it
- transport:
- remote
- credential class:
- unreachable
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- medicare_part_d_out_of_pocket_capshallow
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.
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