Provider Briefing: Everolimus Supply in 2026

Everolimus — marketed as Afinitor, Afinitor Disperz, and Zortress — remains a cornerstone therapy for several oncologic and transplant indications. However, intermittent supply disruptions continue to create challenges for prescribers and their patients in 2026.

This briefing provides a concise overview of the current shortage landscape, prescribing considerations, cost and access barriers, and practical tools to help your patients maintain continuity of care.

Shortage Timeline and Current Status

Everolimus has experienced periodic supply disruptions since the early 2020s. Key milestones include:

• 2020–2022: Generic Everolimus tablets received FDA approval from multiple manufacturers, beginning to ease some supply pressure on brand-name Afinitor
• 2023–2024: Intermittent shortages of specific strengths (particularly 2.5 mg and 7.5 mg) were reported to the FDA, driven by manufacturing constraints and raw material availability
• 2025–2026: Overall supply has stabilized somewhat with increased generic competition, but certain formulations — notably Afinitor Disperz (tablets for oral suspension) — remain periodically limited

The current status varies by formulation and strength. Brand-name Afinitor is generally accessible through specialty pharmacy channels. Generic Everolimus in the 5 mg and 10 mg strengths has the most robust supply. Less common strengths and the Disperz formulation may require additional sourcing effort.

Prescribing Implications

Supply variability creates several clinical considerations:

Treatment Interruptions

Gaps in Everolimus therapy can have clinical consequences. In oncology settings, treatment interruptions may allow disease progression. In transplant patients, missed doses increase the risk of acute rejection. When patients report difficulty filling prescriptions, consider the following:

• Verify whether a different available strength can achieve the same daily dose (e.g., two 5 mg tablets instead of one 10 mg tablet)
• Check if generic Everolimus is available when brand-name is not, or vice versa
• For Zortress patients, confirm that any generic substitution maintains appropriate trough levels with therapeutic drug monitoring

Therapeutic Drug Monitoring

Everolimus has a narrow therapeutic index, particularly in the transplant setting. Any change in formulation, manufacturer, or dosing strategy should be accompanied by trough level monitoring to ensure therapeutic concentrations are maintained (target: 3–8 ng/mL for most transplant indications).

Prior Authorization Considerations

If supply constraints necessitate a switch to an alternative agent, be aware that the new medication may also require prior authorization. Starting this process early — before the patient runs out of Everolimus — can prevent dangerous gaps in therapy.

Availability Picture by Formulation

Here's a practical breakdown of what's generally available in early 2026:

• Afinitor 5 mg, 10 mg tablets: Generally available through specialty pharmacies
• Afinitor 2.5 mg, 7.5 mg tablets: Periodically limited; may require alternative sourcing
• Afinitor Disperz (all strengths): Most supply-constrained formulation; limited to Novartis production
• Generic Everolimus 5 mg, 10 mg: Most widely available; multiple manufacturers
• Generic Everolimus 2.5 mg, 7.5 mg: Available but from fewer manufacturers
• Zortress (all strengths): Generally available through transplant specialty pharmacies

Cost and Access Barriers

Cost remains a significant barrier to Everolimus access, even when supply is adequate:

• Brand-name Afinitor: WAC approximately $18,000–$22,000/month for oncology doses
• Generic Everolimus: $500–$3,000/month depending on strength and pharmacy
• Patient out-of-pocket: Even with insurance, specialty tier copays can exceed $1,000–$3,000/month without copay assistance

Insurance coverage typically requires:

• Prior authorization documenting appropriate indication
• Specialty pharmacy dispensing
• Step therapy documentation (some plans require evidence of prior treatment failure)

Financial Assistance Resources

Help your patients access these programs:

• Novartis Co-pay Assistance Program: Reduces copays to as low as $0–$25/month for commercially insured patients
• Novartis Patient Assistance Foundation: Free medication for qualifying uninsured/underinsured patients
• PAN Foundation, HealthWell Foundation, The Assistance Fund: Copay assistance for patients meeting income criteria
• Specialty pharmacy financial counselors: Most specialty pharmacies have staff dedicated to helping patients navigate coverage and assistance

Tools and Resources for Providers

Several tools can help you and your care team address Everolimus access challenges:

Medfinder for Providers

Medfinder offers real-time pharmacy stock information that can help your office staff locate Everolimus for patients. Rather than having patients call multiple pharmacies, direct them to Medfinder or use it internally to identify in-stock locations.

FDA Drug Shortage Database

The FDA maintains a current list of drug shortages at accessdata.fda.gov. Check periodically for updates on Everolimus availability by formulation and strength.

Specialty Pharmacy Networks

Establishing relationships with 2–3 specialty pharmacies that regularly stock Everolimus ensures you have backup options when one source is temporarily out. Major specialty pharmacy networks include Accredo, CVS Specialty, OptumRx Specialty, and AllianceRx Walgreens Specialty.

Alternative Agents to Consider

When Everolimus is unavailable or not tolerated, consider these alternatives based on indication:

• Renal cell carcinoma: Temsirolimus (Torisel), Cabozantinib (Cabometyx), Axitinib (Inlyta), Lenvatinib + Pembrolizumab
• HR+/HER2- breast cancer: Palbociclib (Ibrance), Ribociclib (Kisqali), Abemaciclib (Verzenio)
• Neuroendocrine tumors: Sunitinib (Sutent), Lanreotide (Somatuline Depot), Octreotide LAR (Sandostatin LAR)
• Transplant rejection: Sirolimus (Rapamune), with appropriate dose adjustment and monitoring
• TSC-related SEGA: Sirolimus may be considered; limited alternatives exist for this indication

For a patient-facing overview of alternatives, see alternatives to Everolimus.

Looking Ahead

The Everolimus supply landscape is expected to continue stabilizing as generic competition matures. Key factors to watch:

• Additional generic manufacturers entering the market
• Potential biosimilar or next-generation mTOR inhibitor development
• Ongoing FDA monitoring of manufacturing compliance
• Evolving insurance coverage and formulary placement as generic pricing decreases

Final Thoughts

Everolimus remains an important therapeutic option across oncology and transplant medicine. While supply disruptions have improved compared to peak shortage periods, providers should maintain awareness of availability challenges and have contingency plans in place.

Proactive use of tools like Medfinder for providers, established specialty pharmacy relationships, and early engagement with financial assistance programs can help ensure your patients maintain uninterrupted access to therapy.

For guidance on helping patients find Everolimus, see our companion article: How to help your patients find Everolimus in stock.