Opdivo (J9299): what insurers contract to pay

Nivolumab · Hematology-Oncology

CareCost Research · Reviewed by Erin Rose

Opdivo (J9299) carries a median commercial contracted rate of 98.2 on the Medicare ASP=100 index — 4.4% below the 102.7 typical-acquisition benchmark and 5.8% below the 104.3 Medicare payment line. 58 insurers report contracted rates across 52 states (1,033 priced cells), covering $1.51B in modeled Part B spend. It ranks #12 of 25 on the CareCost Buy-and-Bill Risk List, with a risk score of 73.5 out of 100.

Contracted rate range across insurers

Shaded band: 10th–90th percentile across insurers. Darker band: 25th–75th percentile. Solid tick: median. Dashed lines: 100 (Medicare ASP), 102.7 (typical acquisition cost), 104.3 (Medicare payment after sequestration).

What each insurer contracts to pay

All 50 insurers with published rates for this code, ranked highest to lowest. Index is a multiple of Medicare ASP (ASP=100).

Insurer	Index	vs. acquisition	Practices	States
BlueCross BlueShield of Nebraska	120.3	+17.1%	34	7
BlueCross BlueShield of South Carolina	112.4	+9.4%	55	6
Regence Idaho	112.3	+9.3%	45	6
Regence Utah	109.7	+6.8%	50	5
Regence BlueCross BlueShield	108.1	+5.3%	56	14
Regence Washington	107.9	+5.1%	75	5
BlueCross BlueShield of Arkansas	106.4	+3.6%	48	21
BCBS North Dakota	106.4	+3.6%	139	3
Wellmark BCBS (Iowa/South Dakota)	105.4	+2.6%	78	10
Blue Shield of California	104.2	+1.5%	124	4
Blue Cross NC	103.6	+0.9%	187	52
Aetna	102.2	−0.5%	535	51
Anthem Massachusetts	102.0	−0.7%	64	25
Premera Blue Cross	101.9	−0.8%	102	9
Capital Blue Cross	101.8	−0.9%	92	35
BlueCross BlueShield of Kansas	101.4	−1.3%	60	5
BlueCross BlueShield of Minnesota	101.1	−1.6%	68	7
Anthem California	100.9	−1.8%	64	4
BlueCross BlueShield of Wyoming	100.6	−2.0%	44	7
Anthem Wisconsin	100.1	−2.5%	144	6
Blue Cross of Idaho	98.6	−4.0%	58	6
Anthem Kentucky	98.2	−4.4%	85	9
UnitedHealthcare	98.2	−4.4%	1,080	51
BlueCross BlueShield of Texas	98.2	−4.4%	42	9
BlueCross BlueShield of Massachusetts	98.2	−4.4%	43	4
Harvard Pilgrim Health Care	98.2	−4.4%	229	10
Anthem Virginia	98.2	−4.4%	72	20
Anthem Missouri	98.2	−4.4%	42	11
Anthem New Hampshire	98.1	−4.5%	49	7
Anthem Georgia	98.1	−4.5%	64	16
Florida Blue	98.1	−4.5%	32	5
Anthem New York	98.1	−4.5%	72	15
Anthem Nevada	98.1	−4.5%	194	4
Regence Oregon	98.1	−4.5%	58	7
Centene	98.1	−4.5%	162	25
Anthem Maine	98.1	−4.5%	65	5
BlueCross BlueShield of Alabama	98.1	−4.5%	91	6
Cigna	98.1	−4.5%	649	51
Kaiser Permanente	98.1	−4.5%	312	8
Anthem Ohio	98.1	−4.5%	80	12
CareFirst BlueCross BlueShield	98.1	−4.5%	58	19
BlueCross BlueShield of Rhode Island	98.1	−4.5%	291	3
Anthem Indiana	98.1	−4.5%	136	25
Anthem Connecticut	98.1	−4.5%	66	5
BlueCross BlueShield of Tennessee	96.3	−6.2%	61	10
HMSA (BCBS Hawaii)	94.9	−7.6%	80	3
BlueCross BlueShield of Michigan	94.9	−7.6%	63	7
BlueCross BlueShield of Louisiana	94.0	−8.5%	54	7
Horizon BCBS of New Jersey	89.9	−12.5%	41	6
BlueCross BlueShield of Arizona	82.4	−19.8%	38	19

The price history

Medicare's payment limit for Opdivo moved +15.0% between Q1 2022 and Q2 2026. Because contracted rates are set as a multiple of ASP, a rising denominator lifts every contracted rate tied to it.

Solid dots: finalized CMS ASP quarters. Hollow dots: preliminary. Values are the Medicare payment limit (ASP + 6%, pre-sequestration) per billing unit.

Part B utilization

Year	Part B spend	Dosage units (M)
2019	$1.78B	72.0
2020	$1.59B	62.1
2021	$1.57B	60.6
2022	$1.85B	64.3
2023	$1.91B	64.6
2024	$1.93B	—
2025	$1.51B	—

Where it pays most and least

Highest-paying states	Index	Insurers
Alaska (AK)	110.9	7
Idaho (ID)	106.6	12
Nebraska (NE)	106.5	9
South Dakota (SD)	105.4	8
Arkansas (AR)	105.0	9

Lowest-paying states	Index	Insurers
Mississippi (MS)	98.1	12
Massachusetts (MA)	98.1	18
Pennsylvania (PA)	98.1	17
Tennessee (TN)	98.1	18

The Nivolumab family

Code	Brand	Index	Insurers	Part B spend
J9289	Opdivo Qvantig	98.8	54	$20M
J9299	Opdivo	98.2	58	$1.51B
J9298	Opdualag	98.2	56	$334M

Within this family, Opdivo Qvantig (J9289) contracts 0.6 points higher on the ASP=100 index than Opdivo (J9299) — 98.8 vs. 98.2.

What this means in dollars

At the median contracted rate, this code models a −$4,342 shortfall per $100,000 of acquisition-benchmark drug cost purchased — illustrative modeled margin exposure, not a claim about any single practice's actual reimbursement.

Based on 1,033 priced contract cells across 58 insurers and 52 states. These are insurers' contracted rates from published machine-readable files — not amounts actually paid on a claim, and not a guarantee of coverage or reimbursement. CareCost Estimate Infusion Reimbursement Index, Issue 01 (Q2 2026), v2.0. CC-BY 4.0. A drug-specific acquisition estimate exists in our warehouse but derives from ASP itself, so we do not print it — the flat 102.7 ODACS benchmark is the honest comparator here.

See also: Nplate · Kyprolis · Enhertu · report home · methodology