Immunotherapy cost: Keytruda, Opdivo, and patient out-of-pocket

Checkpoint-inhibitor immunotherapy, specifically drugs like Keytruda (pembrolizumab), Opdivo (nivolumab), and Tecentriq (atezolizumab), has transformed cancer treatment for many cancer types. It is also the single largest cost driver in modern oncology.

This guide draws on actual CMS Medicare spending data to explain what these drugs cost, what Medicare and commercial insurance pay, and how patients can reduce out-of-pocket.

What checkpoint inhibitor immunotherapy costs

Per the CMS Medicare Part B Spending by Drug dataset, 2023 annual Medicare spending per beneficiary for common immunotherapy drugs:

These figures represent total annual Medicare program spending divided by the patients who received the drug. Commercial insurance pays similar or higher rates.

Per-dose economics: ASP (Average Sales Price) reimbursement rates per milligram:

• Keytruda: ~$55 per mg
• Opdivo: ~$30 per mg
• Tecentriq: ~$82 per mg
• Yervoy: ~$167 per mg

A typical Keytruda dose is 200 mg every three weeks, so roughly $11,000 per dose at Medicare rates. Treatment often continues for 2 years or until disease progression.

Why immunotherapy is expensive

Three reasons:

1. Biologic drugs. These are proteins and antibodies, not small molecules. They are manufactured in cell cultures, which is fundamentally more expensive than chemistry-synthesized pill production.
2. Innovation pricing. The mechanism was novel and first-in-class, with strong efficacy across many indications. Manufacturer pricing reflects market dynamics rather than production cost.
3. Duration of therapy. Unlike older chemotherapy given for a fixed number of cycles, immunotherapy often continues until disease progression or for up to two years. Longer duration multiplies total cost.

Insurance coverage

Medicare

Part B covers infused immunotherapy (Keytruda, Opdivo, Tecentriq, and Yervoy are all given intravenously) at Average Sales Price plus 6 percent. The beneficiary pays 20 percent coinsurance unless Medigap or Medicare Advantage applies.

• With Medigap: typically $0-$500 annual deductible, then $0 coinsurance
• With Medicare Advantage: annual out-of-pocket capped at $8,850 (2024 in-network). One of the best protections for immunotherapy patients.
• Without supplemental: 20% of a $76K annual drug cost = ~$15K annual coinsurance

Commercial insurance

Most commercial plans cover immunotherapy for FDA-approved indications. Typical structure:

• Specialty drug tier with highest cost-sharing
• Prior authorization required
• In-network infusion provider required
• Annual out-of-pocket maximum applies ($9,450 individual / $18,900 family for 2024 ACA plans)

Prior-authorization denials often stem from:

• Not yet trying first-line therapy (step-therapy requirement)
• Biomarker eligibility not documented (e.g., PD-L1 status not reported)
• Off-label use

Appeals frequently succeed when a prior denial cites missing documentation that can be addressed.

Uninsured

Every major immunotherapy drug has a manufacturer patient-assistance program providing drug at no cost to income-eligible uninsured patients:

• Keytruda: Merck Access Program, 855-257-3932
• Opdivo, Yervoy: BMS Access Support, 800-861-0048
• Tecentriq: Genentech Patient Foundation

Eligibility typically requires income at or below 400-500% of federal poverty level. US residents. No exhausted benefits limit for most patients.

What patients actually pay

Three representative scenarios for a patient on Keytruda for one year:

Scenario 1: Medicare with Medigap Plan G

• Medicare pays ~$76K
• Medigap covers Part B coinsurance after $240 (2024) deductible
• Patient pays: ~$240 + Part B premium

Scenario 2: Commercial employer PPO, $2,000 deductible, $8,000 out-of-pocket maximum

• Insurance negotiated rate on drug + infusion ~$76K
• Patient pays $2,000 deductible, then 20% coinsurance until hitting OOP max
• Patient total: $8,000 for the year (capped at OOP max)

Scenario 3: Uninsured, household income below 400 percent of federal poverty level

• Merck Access Program provides drug at no cost
• Patient still owes infusion administration fees (can be covered separately by hospital charity care)
• Patient total: infusion costs only (typically $100-$500 per session via charity care)

Scenario 4: Medicare Advantage, in-network

• Plan handles all Medicare coverage
• Patient pays copays per session until hitting annual OOP max ($8,850 in-network, 2024)
• Patient total: capped at OOP max

Reducing your immunotherapy cost

1. Enroll in a manufacturer PAP if you’re uninsured or underinsured. See your drug’s cost page for the right program.
2. Apply to disease-foundation copay programs. HealthWell, PAN Foundation (merging with PAF as TotalAssist), and CancerCare all maintain active oncology funds. See the financial assistance guide.
3. If on Medicare, consider Medigap Plan G or F if you don’t have it. For cancer patients, the Part B coinsurance coverage is transformative.
4. For commercial plans, review the out-of-pocket maximum. Staying in-network caps your total annual exposure at the plan’s OOP max.
5. Consider a clinical trial. Trials testing experimental combinations often provide the immunotherapy at no cost. See how to find a clinical trial.
6. Ask about biosimilars. Not currently relevant to checkpoint inhibitors (no FDA-approved biosimilars exist for this class as of 2026), but a factor to watch as the drug class matures.

When you won’t qualify

Medicare + commercial copay cards: federal anti-kickback rules prohibit Medicare beneficiaries from using manufacturer commercial-insurance copay cards. They can still apply to the manufacturer’s PAP for free drug if meeting income criteria.

Above income thresholds for PAPs: the ~$60K-$125K income caps exclude some higher-income uninsured patients. For these patients, short-term strategies include enrolling in an ACA marketplace plan or Medicaid spend-down.

Next

• Chemotherapy cost: broader drug cost picture
• CAR-T therapy cost: the other expensive immunotherapy category
• Drug costs: 15 major oncology drugs
• Does Medicare cover cancer treatment?
• Financial assistance for cancer patients