Does Champion Plus (HMO C-SNP) cover everolimus?
Champion Plus (HMO C-SNP)
H6170-010-0 · MA_LOCAL · Medicare Part D
everolimus
Do you get help with your Medicare drug costs?None of these
Optional. Some plans charge less at a preferred pharmacy. Enter your ZIP to see which pharmacies near you take this plan — pick yours and the price above is re-worked for it. Until you do, we show what a standard pharmacy costs. Nothing here is saved.
everolimusunder Champion Plus (HMO C-SNP)
Covered — requires prior authorization
Your plan has to approve it first — your doctor’s office handles it.
What you'd pay
$0per 30-day fill
Part D caps what you pay out of pocket at $2,100 for 2026. From the first fill — no deductible on this drug.
This plan charges the same at every pharmacy in its network — where you fill it will not change this figure.
Amount limit applies — how much depends on the strength you are prescribed — the cap for each one is listed below. You can still fill it; more than that needs your plan's approval, which your doctor's office requests.
- Tier
- Tier 2
- Approval first
- Required
- Try another first
- No
- Amount limit
- Varies by strength
Talk to your pharmacist or doctor before acting on anything here. They can see your full history and this page cannot. Never start, stop, or switch a medication based on it. Coverage rules change and plans make exceptions — your pharmacy can check your exact benefit in seconds.As of Sep 16, 2026 · CMS Part D monthly PUF. Reference information, not medical advice and not a price.
Covered forms and strengths (15)
- everolimus 0.25 MG Oral TabletTier 2Approval first
- everolimus 0.5 MG Oral TabletTier 5Approval first
- everolimus 0.75 MG Oral TabletTier 5Approval first
- everolimus 1 MG Oral TabletTier 5Approval first
- everolimus 10 MG Oral TabletTier 5Approval first56 tablets per 28 days
- everolimus 10 MG Oral Tablet [Torpenz]Tier 5Approval first60 tablets per 30 days
- everolimus 2 MG Tablet for Oral SuspensionTier 5Approval first112 tablets per 28 days
- everolimus 2.5 MG Oral TabletTier 5Approval first28 tablets per 28 days
- everolimus 2.5 MG Oral Tablet [Torpenz]Tier 5Approval first30 tablets per 30 days
- everolimus 3 MG Tablet for Oral SuspensionTier 5Approval first112 tablets per 28 days
- everolimus 5 MG Oral TabletTier 5Approval first30 tablets per 30 days
- everolimus 5 MG Oral Tablet [Torpenz]Tier 5Approval first30 tablets per 30 days
- everolimus 5 MG Tablet for Oral SuspensionTier 5Approval first112 tablets per 28 days
- everolimus 7.5 MG Oral TabletTier 5Approval first60 tablets per 30 days
- everolimus 7.5 MG Oral Tablet [Torpenz]Tier 5Approval first30 tablets per 30 days