Does Medicare Part D Cover Zortress?
Yes — Zortress (Everolimus (transplant)) is covered under Medicare Part D, filled by 28,000 beneficiaries across 248,000 claims in the latest year. It typically sits on tier 3 (non-preferred brand) of standard Part D formularies. Typical copay: $40-$100 per fill, depending on plan formulary.
Zortress Medicare Coverage & Out-of-Pocket Cost
Zortress is covered under Medicare Part D, with the program paying an average of $718 per prescription fill. Zortress typically falls on Tier 3 (non-preferred brand) of standard Part D formularies. Typical copay: $40-$100 per fill, depending on plan formulary.
Your actual out-of-pocket cost depends on three factors: (1) formulary tier — your plan's specific placement; (2) deductible status — most plans require you to meet up to a $590 deductible (2025) before copays kick in; (3) coverage phase — initial coverage, then the donut hole was eliminated in 2025, replaced by a hard $2,000 annual out-of-pocket cap under the Inflation Reduction Act. Once you hit $2,000 in true out-of-pocket spending, the rest of your Part D drugs are free for the year.
Because generic Everolimus (transplant) is available, the single biggest savings move is asking your pharmacist about generic substitution. Generics typically sit on Tier 1 with copays under $10, vs Tier 2-3 placement for brand-name Zortress. Most states allow automatic substitution unless your prescriber writes "dispense as written."
For cash-pay or commercial insurance scenarios, compare prices using GoodRx, SingleCare, or Cost Plus Drugs before filling — discount-program prices sometimes beat Part D copays for lower-cost generics.
How to Confirm Zortress Coverage & Handle a Denial
Medicare Part D coverage of Zortress is set plan-by-plan, not nationally. To confirm your plan covers it, look up Zortress in the Medicare Plan Finder or your plan's online drug list, and check three flags: the formulary tier (drives your copay), prior authorization (PA), and step therapy (ST) or quantity limits.
Because Zortress is a higher-cost drug, plans are more likely to require prior authorization or step therapy — meaning you may need to try a lower-cost alternative first, or your prescriber must document why Zortress is medically necessary. If your plan denies coverage, you have the right to a formulary exception: your prescriber submits a statement of medical necessity, and the plan must respond within 72 hours (24 hours if expedited).
A denial can be appealed through five levels — redetermination by the plan, an independent review entity, an Administrative Law Judge, the Medicare Appeals Council, and finally federal court. Coverage resets every January, so re-check Zortress on your formulary during open enrollment (October 15 – December 7) even if it was covered this year.
Key Facts: Zortress Cost
- Medicare Part D avg
- $718/claim
- Likely Part D tier
- Tier 3 (non-preferred brand)
- Annual cost/patient
- $6,357
- Generic available
- Yes — Everolimus (transplant)
- Manufacturer
- Novartis
- Treats
- Transplant
- YoY price change
- +4.2%
Source: CMS Medicare Part D Spending Dashboard. Tier placement inferred from typical formulary norms — confirm with your specific Part D plan.
Zortress is manufactured by Novartis and prescribed primarily for Transplant. In the most recent Medicare Part D data, 248,000 claims were filed for 28,000 unique beneficiaries, at an average cost of $718 per claim. Average annual cost per beneficiary is $6,357.
Year over year, Medicare spending on Zortress has increased by +4.2%. Because a generic version of Everolimus (transplant) is available, patients can often substitute to reduce out-of-pocket costs. Its patent expires 2023-01-31.
Key Data
| Metric | Value |
|---|---|
| Avg Cost Per Claim | $718 |
| Total Medicare Spending | $178.0M |
| Total Claims | 248,000 |
| Beneficiaries | 28,000 |
| Generic Available | Yes |
| Year-Over-Year Change | +4.2% |
Other Drugs for Transplant
Frequently Asked Questions
Yes. Zortress appears in Medicare Part D claims data, with 28,000 beneficiaries filling 248,000 prescriptions in the latest year. Whether your specific plan covers it depends on that plan's formulary, so confirm on your plan's Summary of Benefits.
It can. Many Part D plans apply prior authorization, step therapy, or quantity limits to Zortress — higher-cost drugs like this one are the most likely to carry these requirements. Prior authorization means your prescriber must document medical necessity before the plan pays. Check your plan's formulary "PA," "ST," or "QL" flags, or ask your pharmacist to run a test claim.
You have appeal rights. Start with a coverage determination / formulary exception request from your plan (your prescriber submits a supporting statement). If denied, you can escalate through five levels: redetermination, an independent review entity, an Administrative Law Judge, the Medicare Appeals Council, and federal court. Expedited 72-hour decisions are available when waiting could jeopardize your health.
Most Medicare Advantage plans include Part D drug coverage (MA-PD), so Zortress is generally available — but each Advantage plan sets its own formulary, tier, and pharmacy network. Coverage and copay can differ from Original Medicare plus a standalone Part D plan, so compare the specific plan's drug list before enrolling.
Zortress is typically placed on Tier 3 (non-preferred brand) of standard Part D formularies. Typical copay: $40-$100 per fill, depending on plan formulary. Your exact tier and cost-sharing are set by your individual plan and can change each plan year.
Use the Medicare Plan Finder at medicare.gov, enter Zortress, and review each plan's formulary, tier, and restrictions. You can also call the number on your insurance card or check the plan's online drug lookup. Coverage is reset every January, so re-check during open enrollment (Oct 15 – Dec 7).
More about Zortress
Yes — Zortress (Everolimus (transplant)) is covered under Medicare Part D, filled by 28,000 beneficiaries across 248,000 claims in the latest year. It typically sits on tier 3 (non-preferred brand) of standard Part D formularies. Typical copay: $40-$100 per fill, depending on plan formulary.
This answer pulls from CMS Medicare Part D Drug Spending data, the authoritative federal source for U.S. Medicare prescription-drug pricing. The headline number above is the direct answer; what follows is the additional context most readers need to use the answer for a real decision rather than just a fact lookup.
For readers turning this answer into action: cross-reference against the underlying CMS Medicare Part D Drug Spending data record before acting on time-sensitive decisions. The site renders the data as it was published; subsequent revisions can shift the picture, and the live federal data is always the authoritative current reference.
Source: CMS Medicare Part D Spending, 2026.