Public record
Sirolimus: the public record
Each table is computed from the named federal dataset as of its data date; the method is under each one.
Label
FDA label facts for sirolimus
The FDA label read for sirolimus (Sirolimus, application NDA021083) was last revised on 2026-10-16. It carries a boxed warning headed "WARNING: IMMUNOSUPPRESSION, USE IS NOT RECOMMENDED IN LIVER OR LUNG TRANSPLANT PATIENTS". Of the 4 population sections checked, 4 are present: pregnancy, lactation, pediatric use, geriatric use.
| Measure | Value | Note |
|---|---|---|
| Label revision date | 2026-10-16 | |
| Label read | Sirolimus | NDA021083, brand-name application |
| Boxed warning | Yes | heading as printed: "WARNING: IMMUNOSUPPRESSION, USE IS NOT RECOMMENDED IN LIVER OR LUNG TRANSPLANT PATIENTS" |
| Pregnancy section | Present | |
| Lactation section | Present | |
| Pediatric use section | Present | |
| Geriatric use section | Present |
How this was calculated
Selected the most recently revised prescription label for this single ingredient from an original manufacturer, preferring a brand-name application. Checked which sections exist and quoted headings and sentences exactly as printed.
One label: the newest prescription label for single-ingredient sirolimus from an original manufacturer
Read from one label. Labels for other brands, strengths or forms of the same ingredient can differ. A missing section heading does not mean there is no guidance. Read the full label before relying on it.
Approvals
FDA approval history for sirolimus
The earliest FDA approval on file for a sirolimus product is 1999-09-15. Drugs@FDA lists 16 applications for it and 151 approved supplements, the most recent on 2026-09-02.
| Measure | Value | Note |
|---|---|---|
| Earliest FDA approval on file | 1999-09-15 | |
| Applications with an approval on file | 16 | |
| New drug applications (NDA) | 5 | |
| Generic applications (ANDA) | 11 | |
| Approved supplements | 151 | label, manufacturing and efficacy changes |
| Most recent supplement approval | 2026-09-02 | |
| Sponsoring companies | 15 |
How this was calculated
Selected applications with a product whose only active ingredient is this substance, then counted approved original and supplemental submissions. The earliest approved original submission is the first approval.
Applications with a single-ingredient sirolimus product in Drugs@FDA, all sponsors and strengths
Older approvals can be missing dates, and tentative approvals are not counted. An approved application does not mean the product is currently marketed.
Patents and generics
Patents and generic approvals for sirolimus
The FDA Orange Book lists 11 approved generic applications for sirolimus, the first approved on 2014-01-08. 8 listed patents on specific brand products have not yet expired, the last on 2045-04-11; generics of other versions are already approved.
| Measure | Value | Note |
|---|---|---|
| Brand-name applications (NDA) | 4 | |
| Approved generic applications (ANDA) | 11 | first approved 2014-01-08 |
| Companies with a generic not marked discontinued | 10 | |
| Listed patents not yet expired | 8 | |
| Latest listed patent expiry | 2045-04-11 | on any product; may cover only one brand formulation |
| Latest listed exclusivity expiry | 2029-03-22 | exclusivity code ODE-391 |
| Earliest approval date on file | 1999-09-15 | |
| Products not marked discontinued | 23 of 25 |
How this was calculated
Selected Orange Book products whose only active ingredient is this substance, then counted applications by type and the distinct patents and exclusivities listed against them. Expired patents are left out.
All single-ingredient sirolimus products in the Orange Book, every brand and strength, files dated 2026-10-09
An approved generic or an expired patent does not show that a generic is on sale. Launch timing also depends on litigation, settlements and supply. Biologics and compounded products are not in the Orange Book.
Medicare Part D
Medicare Part D claims for sirolimus by age group
Of 40,710 Medicare Part D claims for sirolimus in 2024, 25,946 (63.7%) were for enrollees aged 65 and over and 14,764 were for enrollees under 65.
| Measure | Value | Note |
|---|---|---|
| All Part D claims, 2024 | 40,710 | |
| Claims for enrollees aged 65 and over | 25,946 | |
| Claims for enrollees under 65 | 14,764 | mostly people who qualify through disability |
| Share of claims for enrollees aged 65 and over | 63.7% | share of claims, not of patients |
How this was calculated
Summed the national rows for every brand and generic row with this generic name. Claims under 65 are total claims minus claims for enrollees 65 and over.
National Part D claims for single-ingredient sirolimus products, 2024, split at age 65
Medicare mostly covers people 65 and over, so this split describes Medicare enrollees and not use in the general population.
Medicare Part D
Medicare Part D claims for sirolimus by state
California had the most Medicare Part D claims for sirolimus in 2024 (4,944), followed by Florida (3,717) and Texas (3,710). Prescribers in 51 states and territories wrote 40,581 claims in all.
| Measure | Value | Note |
|---|---|---|
| All states and territories, 2024 | 40,581 claims | |
| States and territories with reported claims | 51 | |
| California | 4,944 claims | $2.2M gross drug cost |
| Florida | 3,717 claims | $1.5M gross drug cost |
| Texas | 3,710 claims | $1.6M gross drug cost |
| New York | 2,488 claims | $1.3M gross drug cost |
| Pennsylvania | 1,949 claims | $1.2M gross drug cost |
How this was calculated
Summed claims and drug cost by prescriber state over every brand and generic row with this generic name. Combination products excluded. Rows CMS suppressed for small counts are left out.
Part D claims for single-ingredient sirolimus products by the prescriber's state, 2024
State counts follow population size and where the prescriber practises. They are not per-person rates and do not show any state's coverage rules.
Medicare Part D
Medicare Part D spending on sirolimus
Medicare Part D spending on sirolimus products was $19.1M in 2024 across 40,712 claims, compared with $24.2M in 2023 (-21.2%). Average spending per claim was $468, before rebates.
| Measure | Value | Note |
|---|---|---|
| Total spending, 2024 | $19.1M | |
| Total spending, 2023 | $24.2M | |
| Change in spending, 2023 to 2024 | -21.2% | |
| Claims (prescription fills), 2024 | 40,712 | |
| Average spending per claim, 2024 | $468 | |
| Sirolimus: spending, 2024 | $17.5M | 40,187 claims |
| Hyftor: spending, 2024 | $1.4M | 375 claims |
| Rapamune: spending, 2024 | $223,979 | 150 claims |
How this was calculated
Summed total spending and claims over every brand and generic row with this generic name in the CMS file, using the Overall manufacturer rows. Combination products excluded. Average per claim is spending divided by claims.
Every single-ingredient sirolimus product in Part D (Sirolimus, Hyftor, Rapamune), 2024.
Gross drug cost before manufacturer rebates, so net cost is lower. Part D excludes some uses by law (for example erectile dysfunction, weight loss and hair growth), so claims reflect covered uses only. Compounded products are not included.
Medicaid
Medicaid prescriptions for sirolimus by state
State Medicaid programmes paid for 44,962 sirolimus prescriptions in 2025, with $19.7M reimbursed before rebates. California reported the most (7,817), followed by New York (4,389) and Pennsylvania (3,432); 44 states and territories reported any.
| Measure | Value | Note |
|---|---|---|
| Prescriptions paid by Medicaid, 2025 | 44,962 | |
| Total reimbursed before rebates, 2025 | $19.7M | |
| States and territories reporting | 44 | with at least one count CMS did not suppress |
| California | 7,817 prescriptions | $3.5M reimbursed |
| New York | 4,389 prescriptions | $1.5M reimbursed |
| Pennsylvania | 3,432 prescriptions | $1.6M reimbursed |
| Illinois | 2,507 prescriptions | $928,018 reimbursed |
| Texas | 2,476 prescriptions | $1.6M reimbursed |
How this was calculated
Matched each Medicaid product code to the FDA NDC Directory by labeler and product code, kept finished single-ingredient products, then summed prescriptions and reimbursement by state. National roll-up and suppressed rows dropped.
All single-ingredient sirolimus products in the FDA NDC Directory, fee-for-service and managed care, 2025
Counts under 11 are suppressed by CMS and left out, so totals are a floor. Amounts are before rebates. Differences between states reflect programme size and coverage rules. Compounded products are not included.
Pharmacy cost
Pharmacy acquisition cost (NADAC) for sirolimus
Retail pharmacies paid an average of $0.7127 per unit for SIROLIMUS 1 MG TABLET as of 2026-11-11, compared with $1.48 twelve months earlier (-51.8%). This is a pharmacy purchase cost, not a patient price.
| Measure | Value | Note |
|---|---|---|
| SIROLIMUS 1 MG TABLET | $0.7127 per unit | 12 months earlier $1.48 (-51.8%) |
| SIROLIMUS 1 MG/ML SOLUTION | $4.21 per mL | 12 months earlier $4.89 (-14.0%) |
| SIROLIMUS 0.5 MG TABLET | $0.8326 per unit | 12 months earlier $1.80 (-53.8%) |
| SIROLIMUS 2 MG TABLET | $2.35 per unit | 12 months earlier $4.85 (-51.4%) |
How this was calculated
Matched NADAC product codes to the FDA NDC Directory, kept finished single-ingredient products, and listed the product descriptions with the most package codes. The earlier price is the same package code in the file one year before.
Generic versions of sirolimus in the weekly NADAC file of 2026-11-11, compared with the file of 2025-11-12
NADAC is the average invoice price retail pharmacies pay, from a voluntary survey. It leaves out rebates, dispensing fees and markups, and it is not what a patient or insurer pays. Compounded products are not surveyed.
Adverse event reports
Most reported events in FDA adverse event reports for sirolimus
Through 2026-10-28, FDA had received 16,899 adverse event reports for sirolimus, 13,616 of them marked serious by the reporter. The symptom terms named most often were transplant rejection (809), pneumonia (787) and diarrhoea (671).
| Measure | Value | Note |
|---|---|---|
| All reports received | 16,899 | |
| Reports the reporter marked serious | 13,616 | death, hospitalisation, disability or similar outcome |
| Transplant rejection | 809 reports | |
| Pneumonia | 787 reports | |
| Diarrhoea | 671 reports | |
| Pyrexia | 617 reports | |
| Acute kidney injury | 518 reports |
How this was calculated
Counted FAERS reports listing this active substance, then the reaction terms named most often. A report can name several reactions, and a term can describe the illness being treated and not an effect of the drug. Terms about product use or complaints rather than symptoms (for example off label use) were left out of the list.
Reports where FDA recorded sirolimus as a single-ingredient active substance (any brand), all years to 2026-10-28
FAERS reports are unverified and do not prove the drug caused the event. Reporting rises with use, publicity and lawsuits, so these counts cannot give rates or risks and cannot be compared between drugs.
Recalls
FDA drug recalls naming sirolimus
FDA enforcement reports list 6 drug recall entries naming sirolimus from 2014 to 2024-05-29. 3 of them are for compounded or other unlisted products and 3 for products FDA lists under a label. The most common stated reason was impurities or nitrosamines (3 of 6).
| Measure | Value | Note |
|---|---|---|
| Recall entries on record | 6 | |
| For products FDA lists under an approved or registered label | 3 | |
| For compounded or other unlisted products | 3 | matched by the name in the product description |
| Class I (most serious) | 0 | |
| Class II | 1 | |
| Class III | 5 | |
| Most recent recall reported | 2024-05-29 | |
| Most common stated reason | impurities or nitrosamines | 3 of 6 entries |
How this was calculated
Counted enforcement report entries matched by FDA's listed active substance, or by the name in the product description where FDA lists none. Reasons were grouped by keywords in FDA's stated reason.
Recalls of single-ingredient sirolimus products, plus compounded or unlisted products whose description names it
Each recall covers specific lots from one firm and is not a statement about every product with this ingredient. One event can appear as several entries, one per product.
Clinical studies
Registered clinical studies of sirolimus
ClinicalTrials.gov lists 2,393 registered studies that name sirolimus as an intervention as of 2026-11-11. Of these, 195 are recruiting, 1,303 are completed and 259 are phase 3 studies.
| Measure | Value |
|---|---|
| Registered studies | 2,393 |
| Recruiting now | 195 |
| Not yet recruiting | 56 |
| Completed | 1,303 |
| Terminated, withdrawn or suspended | 379 |
| Phase 3 (including phase 2/3) | 259 |
| Phase 2 (including phase 1/2) | 945 |
| Phase 1 | 432 |
How this was calculated
Searched the ClinicalTrials.gov intervention field for the name, downloaded every matching record and counted by overall status and phase. Combined phases are counted under the higher phase. Phase not applicable covers observational, device and behavioural studies.
Studies whose intervention field matches sirolimus, any condition, any country, all statuses
A registered study is not a result. Counts include studies where the drug is a comparator or background treatment, and studies that never finished or reported.
Articles on Sirolimus
- Rapamycin (Sirolimus) Compassionate Use and Expanded Access: How to Get It and Pay Less
- Rapamycin (Sirolimus) Compounded Equivalent Field
- Rapamycin (Sirolimus) Manufacturer Copay Program: How to Reduce Your Out-of-Pocket Cost
- Rapamycin (Sirolimus) Medicare Advantage Coverage: What Beneficiaries Pay in 2026
- Rapamycin (Sirolimus) Medicare Part D Coverage: What Patients Actually Pay in 2026
- Rapamycin (Sirolimus) VA Coverage Pathway: How Veterans Can Access Sirolimus in 2026