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.
Input Schema
| Name | Required | Description | Default |
|---|---|---|---|
| drug | Yes | Brand or generic drug name, e.g. "Humira", "adalimumab" | |
| state | No | Optional 2-letter US state code, e.g. "TX" |