How Much Does Opdivo Cost With Medicare?
Opdivo (Nivolumab) costs an average of $15,821 per Medicare Part D claim, with total Medicare spending of $5126.0M in the latest year. A generic version is available, which may reduce out-of-pocket costs.
Key Facts: Opdivo Cost
- Medicare Part D avg
- $15,821/claim
- Likely Part D tier
- Tier 4-5 (specialty)
- Annual cost/patient
- $77,667
- Generic available
- Yes — Nivolumab
- Manufacturer
- Bristol-Myers Squibb
- Treats
- Cancer
- YoY price change
- +15.8%
Source: CMS Medicare Part D Spending Dashboard. Tier placement inferred from typical formulary norms — confirm with your specific Part D plan.
Opdivo Medicare Coverage & Out-of-Pocket Cost
Opdivo is covered under Medicare Part D, with the program paying an average of $15,821 per prescription fill. Opdivo typically falls on Tier 4-5 (specialty) of standard Part D formularies. Specialty drugs use coinsurance (25-33% of plan-negotiated price), not flat copays. The 2025 Part D annual out-of-pocket cap is $2,000.
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 Nivolumab 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 Opdivo. 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.
Opdivo is manufactured by Bristol-Myers Squibb and prescribed primarily for Cancer. In the most recent Medicare Part D data, 324,000 claims were filed for 66,000 unique beneficiaries, at an average cost of $15,821 per claim. Average annual cost per beneficiary is $77,667.
Year over year, Medicare spending on Opdivo has increased by +15.8%. Because a generic version of Nivolumab is available, patients can often substitute to reduce out-of-pocket costs. Its patent expires 2023-01-31.
Opdivo belongs to the Cancer Immunotherapy & Targeted Therapy class. Checkpoint inhibitors (Keytruda, Opdivo) unleash the immune system to attack cancer by blocking proteins (PD-1/PD-L1) that cancer cells use to hide. Kinase inhibitors (Ibrance, Xtandi) block specific enzymes that drive cancer cell growth. IMiDs (Revlimid) modify the immune system and directly kill cancer cells. CDK4/6 inhibitors (Ibrance, Kisqali) stop cancer cells from dividing.
Key Data
| Metric | Value |
|---|---|
| Avg Cost Per Claim | $15,821 |
| Total Medicare Spending | $5126.0M |
| Total Claims | 324,000 |
| Beneficiaries | 66,000 |
| Generic Available | Yes |
| Year-Over-Year Change | +15.8% |
Other Drugs for Cancer
Frequently Asked Questions
Medicare Part D pays an average of $15,821 per claim for Opdivo. Opdivo is typically placed on Tier 4-5 (specialty) of standard Part D formularies. Specialty drugs use coinsurance (25-33% of plan-negotiated price), not flat copays. The 2025 Part D annual out-of-pocket cap is $2,000. As of 2025, total annual out-of-pocket on Part D is capped at $2,000 under the Inflation Reduction Act.
Yes. Opdivo appears in Medicare Part D claims data, with 66,000 beneficiaries filling 324,000 prescriptions in the latest year. Specific coverage depends on your plan's formulary — call the number on your insurance card or check the plan's Summary of Benefits to confirm prior authorization, step therapy, or quantity limit requirements.
Opdivo (Nivolumab) costs an average of $15,821 per Medicare Part D claim, with total Medicare spending of $5126.0M in the latest year. A generic version is available, which may reduce out-of-pocket costs.
Yes. A generic version of Nivolumab is available, which typically costs 80-95% less than brand-name Opdivo. Ask your pharmacist about generic substitution — most state laws allow automatic substitution unless your prescriber writes "dispense as written."
Medicare beneficiaries cannot use manufacturer copay cards (anti-kickback statute), but several options exist: (1) Apply to charity copay foundations like the PAN Foundation, NeedyMeds, HealthWell Foundation, or Patient Advocate Foundation — many cover cancer drugs; (2) Ask your prescriber about therapeutic alternatives in the same drug class that may be on a lower tier; (3) For some drugs, paying cash via GoodRx or Cost Plus Drugs can beat your Medicare copay — always compare before filling; (4) If your income is below 150% of the federal poverty level, you may qualify for the Medicare Extra Help (Low-Income Subsidy) program, which reduces Part D costs to near-zero.
Opdivo is manufactured by Bristol-Myers Squibb. The FDA application number is BLA125057.
Opdivo (Nivolumab) is primarily prescribed for Cancer.
Medicare Part D spending on Opdivo has increased +15.8% year over year. Total program spending reached $5126.0M in the latest reporting year.
Opdivo (Nivolumab) costs an average of $15,821 per Medicare Part D claim, with total Medicare spending of $5126.0M in the latest year. A generic version is available, which may reduce out-of-pocket costs.
The data source behind this answer is CMS Medicare Part D Drug Spending data. Every figure on the page traces back to that source; the methodology page describes the inputs and the refresh cadence in full detail.
A practical caveat: the headline answer above reflects the most recent CMS Medicare Part D Drug Spending data vintage; underlying data is often revised for months after first publication, and the right reference for any specific decision is whichever vintage is current at the time of the decision. The as-of date is stamped on every page.
Source: CMS Medicare Part D Spending, 2026.