Everolimus
Specialty Drug

Afinitor

EVEROLIMUS decreases the activity of your immune system. Afinitor is used to treat certain types of cancer. Zortress is used for kidney and liver transplant rejection prophylaxis. Compare kinase inhibitors.

Everolimus Medicare Coverage

Overview

Does Medicare cover Afinitor?

Yes.
100% of Medicare Part D and Medicare Advantage plans cover this drug.

How much is my Afinitor co-pay with Medicare?

It depends. Which coverage stage are you in? Click on a tab below…

Deductible
Typical
Donut Hole
Post-Donut Hole
Co-Pay Range
$8299 – $14837
In the Deductible co-pay stage, you are responsible for the full cost of your prescriptions. Your Medicare deductible cannot exceed $360 in 2016.
Co-Pay Range
$2075 – $4896
In the Typical co-pay stage, your deductible has been satisfied, and Medicare pays the majority of your drug costs.
Co-Pay Range
$3734 – $6677
In the Donut Hole (also called the Coverage Gap) stage, you’ll pay more for your prescriptions. In 2016, the Donut Hole begins once you’ve spent $3,310 in one year.
Co-Pay Range
$15 – $742
In the Post-Donut Hole (also called Catastrophic Coverage) stage, Medicare will cover most of your drug costs. In 2016, this stage begins once you have spent $4,850.
Want an exact price for your co-pay?

Ways to Save on Everolimus

Here are some ways that may lower the cost of your Afinitor prescription.

Manufacturer Coupon
Pay as little as $25 per month with insurance.
Patient Assistance Program
Receive your prescription at no charge if you are eligible.
Patient Assistance Program
Call to get more information on how they can financially assist you with your prescription.

Find Your Everolimus Medicare Co-Pay

Here are average co-pays for some of the most popular Medicare plans. Be sure to add your plan to see your specific co-pay. If a price is shown in red, GoodRx has found discount prices that are lower than your Medicare co-pay.

Average Co-Pay for 30 tablets of Afinitor 10mg

Medicare Plan Name Average Co-Pay
AARP MedicareComplete (HMO) $4046
AARP MedicareComplete Plan 1 (HMO) $4247
AARP MedicareComplete SecureHorizons (HMO) $3919
AARP MedicareRx Preferred (PDP) $4744
AARP MedicareRx Saver Plus (PDP) $3709
Aetna Medicare Rx Saver (PDP) $3709
Cigna-HealthSpring Preferred (HMO) $4550
Cigna-HealthSpring Rx Secure (PDP) $3709
Cigna-HealthSpring Rx Secure-Extra (PDP) $4006
EnvisionRxPlus Silver (PDP) $3709
Express Scripts Medicare - Value (PDP) $3709
First Health Part D Value Plus (PDP) $4896
Humana Enhanced (PDP) $4835
Humana Preferred Rx Plan (PDP) $3663
Humana Walmart Rx Plan (PDP) $3661
Kaiser Permanente Senior Advantage (HMO) $4896
MedicareBlue Rx Standard (PDP) $3709
SilverScript Choice (PDP) $4861
Symphonix Value Rx (PDP) $3709
WellCare Classic (PDP) $3709
Don't see your Medicare plan above?

Find and configure your plan to see exact co-pay prices for your meds.

Everolimus Medicare Formulary Information & Restrictions

Are there any restrictions on coverage?

Some Medicare plans have restrictions on coverage of Afinitor that may include:

Quantity Limits

Most Medicare plans restrict the amount of this prescription that can be purchased at one time. If you need to purchase a greater amount at one time, it may not be covered. Your options are to wait until that time period has passed before refilling, call your plan and ask for an exception, or consider using a GoodRx discount instead of Medicare to find the best price for this prescription.

Prior Authorization

Most Medicare plans will require you to obtain their authorization before they will provide coverage for this prescription. You’ll need to contact your plan and they may require you to have your doctor fill out paperwork indicating why you need this prescription. If you do not receive authorization or don’t want to go through this process, you may want to consider using a GoodRx discount instead of Medicare to find the best price for this prescription.

What drug tier is Afinitor typically on?

Tier 5

Medicare plans typically list Afinitor in Tier 5 of their formulary. Tier 5 drugs are usually non-preferred brand-name drugs. Tier 5 drugs cost more than Tier 1, 2, 3 and 4 drugs.

Does your plan have restrictions?

See discount prices that can save you money when your Medicare plan doesn't work for you.

Medicare prices are provided by the Centers for Medicare and Medicaid Services (CMS). If you encounter any issues, please let us know.
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