FillMapSummaCare Standard Gold with Adult Vision · 52664-52664OH1540012-0About this plan

Does SummaCare Standard Gold with Adult Vision cover everolimus?

1 · Your plan

SummaCare Standard Gold with Adult Vision

52664-52664OH1540012-0 · ACA · ACA Marketplace

2 · Your medication

everolimus

everolimusunder SummaCare Standard Gold with Adult Vision

Covered — some forms require prior authorization

16 of 20 covered forms have a condition attached. Your plan has to approve it first — your doctor’s office handles it.

What you'd pay

$250per 30-day fill

From the first fill — no deductible on this drug.

This is the standard amount. If you qualified for a cost-sharing reduction when you enrolled, set your level above and this will follow it.

Amount limit applies — you can still fill it, but your plan caps how much you get at a time. This plan's drug list records the cap without stating the amount — your pharmacy can tell you when they fill it.

Tier: Specialty drugs
Approval first: Required
Try another first: No
Amount limit: Yes

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 14, 2026 · CMS QHP machine-readable. Reference information, not medical advice and not a price.

Your cost-sharing levelMarketplace plans publish a different amount for each level. Your eligibility notice says which applies. Nothing here is saved.

Covered forms and strengths (20)

everolimus 0.25 MG Oral Tablet
everolimus 0.5 MG Oral Tablet
everolimus 0.75 MG Oral Tablet
everolimus 1 MG Oral Tablet
everolimus 10 MG Oral TabletApproval first
everolimus 10 MG Oral Tablet [Torpenz]Approval firstAmount limit
everolimus 10 MG Oral Tablet [Yulithira]Approval firstAmount limit
everolimus 2 MG Tablet for Oral SuspensionApproval first
everolimus 2.5 MG Oral TabletApproval firstAmount limit
everolimus 2.5 MG Oral Tablet [Torpenz]Approval firstAmount limit
everolimus 2.5 MG Oral Tablet [Yulithira]Approval firstAmount limit
everolimus 3 MG Tablet for Oral SuspensionApproval first
everolimus 3 MG Tablet for Oral Suspension [Afinitor]Approval first
everolimus 5 MG Oral TabletApproval firstAmount limit
everolimus 5 MG Oral Tablet [Torpenz]Approval firstAmount limit
everolimus 5 MG Oral Tablet [Yulithira]Approval firstAmount limit
everolimus 5 MG Tablet for Oral SuspensionApproval first
everolimus 7.5 MG Oral TabletApproval firstAmount limit
everolimus 7.5 MG Oral Tablet [Torpenz]Approval firstAmount limit
everolimus 7.5 MG Oral Tablet [Yulithira]Approval firstAmount limit

← All coverage for everolimus