Nivolumab
Specialty Drug

Opdivo

NIVOLUMAB is a monoclonal antibody. It is used to treat melanoma, lung cancer, kidney cancer, and Hodgkin lymphoma. Compare PD inhibitors.

Nivolumab Medicare Coverage

Overview

Does Medicare cover Opdivo?

Yes.
83% of Medicare Part D and Medicare Advantage plans cover this drug.

How much is my Opdivo co-pay with Medicare?

It depends. Which coverage stage are you in? Click on a tab below…

Deductible
Typical
Donut Hole
Post-Donut Hole
Co-Pay Range
$1004 – $1153
In the Deductible co-pay stage, you are responsible for the full cost of your prescriptions. Your Medicare deductible cannot exceed $360 in 2016.
Co-Pay Range
$251 – $1153
In the Typical co-pay stage, your deductible has been satisfied, and Medicare pays the majority of your drug costs.
Co-Pay Range
$444 – $1153
In the Donut Hole (also called the Coverage Gap) stage, you’ll pay more for your prescriptions. In 2016, the Donut Hole begins once you’ve spent $3,310 in one year.
Co-Pay Range
$15 – $1153
In the Post-Donut Hole (also called Catastrophic Coverage) stage, Medicare will cover most of your drug costs. In 2016, this stage begins once you have spent $4,850.
Want an exact price for your co-pay?

Ways to Save on Nivolumab

Here are some ways that may lower the cost of your Opdivo prescription.

Manufacturer Coupon
Pay as little as $25 per infusion with insurance.
Patient Assistance Program
Receive your prescription at no charge if you are eligible.

Find Your Nivolumab Medicare Co-Pay

Here are average co-pays for some of the most popular Medicare plans. Be sure to add your plan to see your specific co-pay. If a price is shown in red, GoodRx has found discount prices that are lower than your Medicare co-pay.

Average Co-Pay for 1 vial (4ml) of Opdivo 40mg/4ml

Medicare Plan Name Average Co-Pay
AARP MedicareComplete (HMO) $279
AARP MedicareComplete Plan 1 (HMO) $293
AARP MedicareComplete SecureHorizons (HMO) $270
AARP MedicareRx Preferred (PDP) $327
AARP MedicareRx Saver Plus (PDP) $255
Aetna Medicare Rx Saver (PDP) $260
Cigna-HealthSpring Preferred (HMO) $315
Cigna-HealthSpring Rx Secure (PDP) $251
Cigna-HealthSpring Rx Secure-Extra (PDP) $271
EnvisionRxPlus Silver (PDP)Lower price available $1153
Express Scripts Medicare - Value (PDP) $259
First Health Part D Value Plus (PDP) $343
Humana Enhanced (PDP) $335
Humana Preferred Rx Plan (PDP) $254
Humana Walmart Rx Plan (PDP) $254
Kaiser Permanente Senior Advantage (HMO) $354
MedicareBlue Rx Standard (PDP)Lower price available $1153
SilverScript Choice (PDP)Lower price available $1153
Symphonix Value Rx (PDP) $256
WellCare Classic (PDP)Lower price available $1153
Don't see your Medicare plan above?

Find and configure your plan to see exact co-pay prices for your meds.

Nivolumab Medicare Formulary Information & Restrictions

Are there any restrictions on coverage?

Some Medicare plans have restrictions on coverage of Opdivo that may include:

Prior Authorization

Most Medicare plans will require you to obtain their authorization before they will provide coverage for this prescription. You’ll need to contact your plan and they may require you to have your doctor fill out paperwork indicating why you need this prescription. If you do not receive authorization or don’t want to go through this process, you may want to consider using a GoodRx discount instead of Medicare to find the best price for this prescription.

What drug tier is Opdivo typically on?

Tier 5

Medicare plans typically list Opdivo in Tier 5 of their formulary. Tier 5 drugs are usually non-preferred brand-name drugs. Tier 5 drugs cost more than Tier 1, 2, 3 and 4 drugs.

Does your plan have restrictions?

See discount prices that can save you money when your Medicare plan doesn't work for you.

Medicare prices are provided by the Centers for Medicare and Medicaid Services (CMS). If you encounter any issues, please let us know.
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