Opdivo and cost

As with all medications, the cost of Opdivo can vary. Factors that may affect the price you’ll pay include:

• your treatment plan
• your insurance coverage
• the cost of the visit to your healthcare professional to receive doses of Opdivo
• whether Opdivo has a savings program (see the “Financial and insurance assistance” section below)

To find out what the cost of Opdivo will be for you, talk with your doctor or insurance provider.

Insurance considerations

Below is information you may want to consider if you have insurance and receive Opdivo.

Prior authorization. If you have insurance, your insurance company may require prior authorization before it covers Opdivo. This means the company and your doctor will discuss Opdivo in regard to your treatment. The insurance company will then determine whether to cover the medication. If a drug requires prior authorization but you start treatment without the prior approval, you could pay the full cost of the medication. You can ask your insurance company whether Opdivo requires prior authorization.

Type of insurance coverage. Opdivo is given by your doctor or another healthcare professional. If you have insurance, the price of your Opdivo doses may be billed through your medical coverage instead of the prescription drug portion of your insurance plan. This depends on your specific insurance plan and where you receive your Opdivo doses, such as at your doctor’s office, an infusion clinic, or a hospital. If you have questions about this process, contact your doctor or your insurance provider.

Opdivo contains the active ingredient nivolumab, and it’s available only as a brand-name biologic drug. It doesn’t come in a biosimilar version. A biosimilar medication is a drug that’s similar to a brand-name biologic drug (the parent drug). Also, biosimilars tend to cost less than brand-name medications.

WHY ARE COSTS DIFFERENT FOR BIOLOGIC DRUGS VS. BIOSIMILAR DRUGS?

Biologic drugs can be expensive because of the research needed to test their safety and effectiveness. The manufacturer of a biologic drug can sell it for up to 12 years. When the biologic drug’s patent expires, multiple manufacturers can create biosimilar versions. This marketplace competition may lead to lower costs for biosimilars. Also, because biosimilars are very similar to biologic drugs, they don’t require the same costly testing.

If you need financial support to pay for Opdivo, or if you need help understanding your insurance coverage, help is available. For example:

• A program called Bristol Meyers Squibb Access Support is available for Opdivo. For more information and to find out if you’re eligible for support, call 800-861-0048 or visit the program website.
• Some websites provide details about drug assistance programs, ways to make the most of your insurance coverage, and links to savings cards and other services. Two such websites are:
  • Medicine Assistance Tool
  • NeedyMeds

To learn more about saving money on prescriptions with or without insurance, check out this article.

Here are answers to some frequently asked questions about drug cost and Opdivo.

Does Opdivo’s cost depend on my dosage?

Opdivo’s cost may depend on your dosage and treatment plan. It also depends on whether you have insurance and the type of coverage the plan provides. To find out what you’ll pay for Opdivo, talk with your doctor or your insurance provider.

Does Medicare cover the cost of Opdivo?

Yes, Medicare typically covers the cost of Opdivo. You’ll receive your Opdivo doses by IV infusion in a healthcare setting. Medicare Part B covers medications that you receive at your doctor’s office or clinic. So Medicare may cover some of Opdivo’s cost.

To find out your cost for Opdivo, contact your Medicare representative. You can ask them whether you’ll owe a deductible or coinsurance payment.

To learn about Medicare, see the “Next steps” section just below. For information about Medicare and Opdivo specifically, you can refer to this article.

Now that you’ve learned about cost and Opdivo, you may still have some questions. It may be helpful to talk with your doctor or pharmacist, who can provide personalized guidance about cost issues related to Opdivo. But if you have health insurance, you’ll need to talk with your insurance provider to learn the actual cost you would pay for Opdivo.

Here are some other resources you may find helpful:

• Medicare drug coverage. For information about Medicare and Opdivo refer to this article. To learn about Medicare coverage for drugs, see these articles about Medicare prescription drug plans, drug coupons and Medicare, and the Medicare drug list.
• More details. For details about other aspects of Opdivo, refer to this article.
• Dosage. Learn about Opdivo and dosage by viewing this article.
• Side effects. For details about Opdivo’s side effects, see this article. You can also look at the Opdivo prescribing information.
• Drug comparison. Learn how Opdivo compares with Tecentriq and Keytruda.
• Information about your condition. For information about Opdivo and lung cancer, see this article. You can also view our cancer hub.

Disclaimer: Medical News Today has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.