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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.
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).
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 |
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.
| 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 | — |
| 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 |
| 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.
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.
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