everolimus 5 MG Oral Tablet [Afinitor]
everolimus
RxCUI: 845518
What the CMS Formulary Data Shows for everolimus 5 MG Oral Tablet [Afinitor]
Per the CMS 2026 Part D formulary file, everolimus 5 MG Oral Tablet [Afinitor] (RxNorm concept RXCUI 845518, generic name everolimus) appears on 2 distinct formulary files spanning 8 Medicare Part D plan offerings - 0.2% of enrollable Part D products, selective placement; verify formulary inclusion before enrolling. Tier placement ranges from Tier 1 to Tier 5, with a cross-plan average of Tier 3.
Real-world access to everolimus 5 MG Oral Tablet [Afinitor] depends on utilization management as much as tier placement: 100% of covering formularies require prior authorization. 0% require step therapy. 100% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 6,726 Part D beneficiaries filled everolimus 5 MG Oral Tablet [Afinitor] in 2023, with total plan-and-beneficiary spending of $240,732,669 and an average per-beneficiary annual cost of $35,791.36. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry everolimus 5 MG Oral Tablet [Afinitor] today.
Coverage Details
- Formularies covering
- 2
- Plans covering
- 8
- Coverage rate
- 0.2%
- Tier range
- Tier 1 – Tier 5
- Average tier
- Tier 3, Preferred Brand
Restrictions
- Prior authorization required
- 100% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 100% of formularies
2023 Medicare Spending
- Beneficiaries
- 6,726
- Total spending
- $240,732,669
- Avg per beneficiary
- $35,791.36
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering everolimus 5 MG Oral Tablet [Afinitor]
8 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| Hamaspik Medicare Choice (HMO D-SNP) | HAMASPIK, INC. | T1 | Yes | $0 | NY |
| Hamaspik Medicare Select (HMO D-SNP) | HAMASPIK, INC. | T1 | Yes | $34.50 | NY |
| Óptimo Plus (PPO) | TRIPLE S ADVANTAGE, INC. | T5 | Yes | $0 | PR |
| Contigo Plus (HMO C-SNP) | TRIPLE S ADVANTAGE, INC. | T5 | Yes | $0 | PR |
| Brillante (HMO-POS) | TRIPLE S ADVANTAGE, INC. | T5 | Yes | $0 | PR |
| Enlace Plus (HMO) | TRIPLE S ADVANTAGE, INC. | T5 | Yes | $0 | PR |
| ContigoEnMente (HMO C-SNP) | TRIPLE S ADVANTAGE, INC. | T5 | Yes | $0 | PR |
| Ahorro Plus (HMO) | TRIPLE S ADVANTAGE, INC. | T5 | Yes | $0 | PR |
Frequently Asked Questions
Is everolimus 5 MG Oral Tablet [Afinitor] covered by Medicare Part D?
Yes, everolimus 5 MG Oral Tablet [Afinitor] is covered by 8 Medicare Part D plans (0.2% of all Part D formularies).
What tier is everolimus 5 MG Oral Tablet [Afinitor] on Medicare Part D plans?
everolimus 5 MG Oral Tablet [Afinitor] averages Tier 3 across Part D plans, ranging from Tier 1 to Tier 5.
Does everolimus 5 MG Oral Tablet [Afinitor] require prior authorization?
100% of Part D formularies require prior authorization for everolimus 5 MG Oral Tablet [Afinitor]. Step therapy: 0%. Quantity limits: 100%.
How much does Medicare spend on everolimus 5 MG Oral Tablet [Afinitor]?
In 2023, total Medicare Part D spending on everolimus 5 MG Oral Tablet [Afinitor] was $240,732,669, covering 6,726 beneficiaries. The average spend per beneficiary was $35,791.36.
Read our methodology - how this data is sourced, computed, and verified.