Medicare Part D coverage · everolimus · RxCUI 845518

everolimus 5 MG Oral Tablet [Afinitor]

Per the CMS 2026 Part D formulary file, everolimus 5 MG Oral Tablet [Afinitor] is covered by 8 Medicare Part D plans (0.2% of enrollable products), averaging Tier 3, with prior authorization required on 100% of covering formularies.

0.2%
Plan coverage
8
Plans covering
T3
Avg tier
100%
Prior auth required

Verify with CMS →

Important: Drug coverage and costs vary by plan and location. Verify coverage directly with your Medicare plan before filling a prescription. This is informational data only and should not replace advice from your healthcare provider or pharmacist.

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

2 plans
Tier 1, Preferred Generic
6 plans
Tier 5, Specialty

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.

Nationwide similar Part D drugs

Data-derived peers across the CMS Part D formulary extract: nearest average tier placement and nearest prior-authorization rate. Not therapeutic alternatives or same-generic strengths.

Closest average formulary tier

Similar prior-authorization rate

Data sourced from the Centers for Medicare & Medicaid Services (CMS). See our methodology for details. Retrieved and formatted by PlainMedicare