Cevimeline (Evoxac)

How Medicare covers it

Part D (forms used at home). Part A during a covered inpatient stay. No Part B clinician-administered form in the CMS Part B spending file.

What it treats

Dry mouth symptoms in people with Sjögren's syndrome, an autoimmune disease that damages the glands that make saliva and tears.

What it is for, in depth

Cevimeline treats the dry mouth of Sjögren's syndrome, a long-term autoimmune disease in which the immune system attacks the glands that make moisture, most often the salivary and tear glands. Constant dry mouth is more than uncomfortable: without saliva, tooth decay, gum disease, mouth sores, trouble swallowing, and difficulty speaking all become more likely. Cevimeline is one of only two prescription medicines approved to make the salivary glands work harder, and it is covered under Part D as an oral capsule. Coverage questions are usually about tier placement rather than whether the drug is covered at all.

How it works

Cevimeline turns on muscarinic receptors on the salivary glands, which makes the glands produce more saliva so the mouth feels less dry.

How it is taken

A capsule taken by mouth, usually 30 mg three times a day.

Common side effects

['Extra sweating', 'Nausea', 'Runny or stuffy nose', 'Diarrhea', 'Headache']

Serious warnings

['Slowed heartbeat or fainting in people with heart conduction problems', 'Breathing problems in people with asthma or COPD', 'Blurred vision or trouble seeing at night while driving']

Who should be careful

['People with uncontrolled asthma or COPD', 'People with heart disease or a slow heartbeat', 'People with narrow-angle glaucoma or acute iritis; it is not used when pupil constriction is harmful', 'People with gallstones or kidney stones, which can be aggravated by increased smooth-muscle activity']

Major interactions

['Beta blockers such as metoprolol, which can worsen heart conduction effects', 'Other cholinergic drugs and cholinesterase inhibitors, which can add to the effects', 'Drugs that strongly affect CYP2D6 or CYP3A4, which can change cevimeline levels']

Cost and saving notes

Cevimeline is an older brand-name drug (Evoxac) with generic versions, and generics usually sit on lower Part D tiers than brand-only drugs. If your plan prices it high, ask for a tier exception with your prescriber's note, and check Extra Help if your income is limited. The 2027 Part D out-of-pocket cap is $2,400 for the year, and the Medicare Prescription Payment Plan can spread that cost across the year instead of paying it all at once.

Why it is in its tier

Cevimeline (Evoxac) sits on Tier 4 in 70.74% of the plans that list it (1941 of 2744 listing plans). Tier 4 is the non-preferred tier — higher copays or coinsurance. The data-visible drivers: It is sold both as a brand product and in generic form, and the CMS dashboard puts its average Part D spending at about $637 per beneficiary for 2024 — a relatively low-cost drug, which matches where plans place it. Only 49.94% of Part D plans list it at all, so many readers will find their plan does not list it and covers a similar drug instead. The tier shown is the most common one; individual plans vary.

Sources

• EVOXAC (CEVIMELINE HYDROCHLORIDE) CAPSULE [COSETTE PHARMACEUTICALS, INC.] — DailyMed
• MedlinePlus — National Library of Medicine
• MedlinePlus — Cevimeline

What official patient guides say

Cevimeline comes as a capsule you take by mouth, usually three times a day, at around the same times every day. If you miss a dose, take it as soon as you remember it, but if it is almost time for the next dose, skip the missed dose and go back to your regular schedule — do not take a double dose to make up for one you missed. Keep the capsules in the container they came in, tightly closed and out of the reach of children, and store them at room temperature away from extra heat and moisture, not in the bathroom. When you no longer need the medicine, take it to a medicine take-back program instead of flushing it down the toilet.

Source: MedlinePlus — Cevimeline

Part D formulary coverage

Source: CMS Prescription Drug Plan Formulary, Pharmacy Network, and Pricing Information Files — Monthly file 2026-10-15 (plan year 2027), file 2027_20261008.zip (data.cms.gov dataset ed1496ea-23e7-41f1-9292-172fa842ccfb): basic drugs formulary file + plan information file, both dated 20261031 inside the zip; downloaded and aggregated 2026-10-30. Medication RxCUI sets resolved through the NLM RxNav (RxNorm) API.

What you pay

Without insurance, the cash benchmark is 0.72398 per unit (CEVIMELINE HCL 30 MG CAPSULE) — about nan for 30 units. NADAC benchmark — the average price pharmacies pay (CMS, as of 2026-11-04). Pharmacy shelf prices vary.

A tier is not a price; what you pay depends on your plan, pharmacy, and benefit stage; Extra Help or Medicaid can lower it further.

Sources: CMS Plan Benefit Package + formulary data; CMS NADAC · Checked 2026-11-07

Coverage by plan and tier

Of the 5,495 Medicare drug plans we track for 2027, 2,744 list Cevimeline (Evoxac) — 49.9% of plans. Most of those plans put it on Tier 4: 1,941 plans, 70.7% of the plans that list it. Other plans place it on Tier 1 (342 plans), Tier 2 (316 plans) or Tier 3 (145 plans). For example: Aetna Medicare Dual Extra (HMO D-SNP) puts it on Tier 4; Aetna Medicare Dual Extra Care (PPO D-SNP) puts it on Tier 4; Aetna Medicare Value Plus (PPO) puts it on Tier 4. You can compare these plans side by side on our Medicare Advantage hub. A tier is not a price. What you pay also depends on whether you have met your plan';s deductible, whether the drug costs a flat copay or a share of the price, and whether you get Extra Help or Medicaid.

Read next

• Part D in 2027: The $700 Deductible, the $2,400 Cap, and the $35 Insulin Rule
• Extra Help in 2027: Lower Drug Copays and Who Qualifies
• Checking Medicare Savings Programs and Extra Help

Part D spending averages (2024)

Source: CMS Medicare Part D Spending by Drug (Drug Spending Dashboard), release RY26 P04 V10, data through 2024 (DSD_PTD_RY26_P04_V10_DY24_BGM.csv), downloaded 2026-10-30

Companies covering this drug

Part D and Medicare Advantage plan sponsors that list this drug on a formulary, 50 at a time.