OBJECTIVES:  To estimate the budget impact of everolimus-exemestane versus the most commonly used regimens in the Egyptian practice; gemcitabine-paclitaxel and capecitabine-docetaxel for a health care plan that introduces everolimus for post-menopausal hormone receptor positive, human epidermal growth factor receptor-2 negative metastatic breast cancer (HR+,HER2-MBC) patients over three years. METHODS: Drug and medical budget impacts (2013 EGP) were estimated over the first three years of the three drug regimens use from the health insurance perspective. Epidemiology data were used to estimate target population size. The treatment data for MBC patients were obtained from published and nonpublished sources.  The model considered 2 scenarios—without (pre) and with (post) everolimus-exemestane. Monthly medical costs were calculated for the pre- and post-progression phase. Results were considered on a per member per month (PMPM) basis to examine the relative impact on the plan. Deterministic sensitivity analyses were conducted. RESULTS: In a real-world 6,055,902 targeted patients, 288,261 of them were found to be candidates for everolimus-exemestane regimen. For patients taking gemcitabine-paclitaxel and capecitabine-docetaxel regimens, the estimated incremental cost PMPM was LE3.00 and LE2.94 respectively for each after three years. The estimated incremental cost PMPM for the gemcitabine-paclitaxel population was LE0.62, LE2.60 and LE5.77 for year 1, 2 and 3 respectively while for the capecitabine-docetaxel population was LE0.59, LE2.54 and LE5.70 for year 1, 2 and 3 respectively. The capecitabine-docetaxel results were most sensitive to the cost of everolimus while gemcitabine-paclitaxel results were most sensitive to the number of eligible patients. CONCLUSIONS: Increased acquisition costs of everolimus-exemestane for HR+,HER2-MBC treatment are expected to be obviously offset by both the reduced number of progressed patients and the relatively small medical costs due to avoided adverse events of each of gemcitabine-paclitaxel and capecitabine-docetaxel regimens. The expected budget impact of covering everolimus for this group of patients was relatively small.