The year long investigation, Cancer Calculus, goes into detail about Merck’s strategies to keep its blockbuster cancer drug Keytruda both very expensive and widely prescribed – even in cases when the benefits are limited, the authors conclude.

Drawing on pricing data from 31 countries, the journalists found stark disparities in terms of affordability, with Keytruda comparatively less affordable in poorer countries. 

read an overview of the investigation here

Pricing particularly chaotic in the US

The journalists found pricing particularly chaotic in the US, where a 2003 Medicare provision prohibits the government from negotiating prices for most drugs. The cost of a 200 mg dose can range from USD 5,858 to USD 43,800, according to data provided to ICIJ by Serif Health, depending on the insurers and providers involved and whether the infusion is administered in a hospital or a medical office.

Related article

In focus – U.S. drug prices

The stories have been in the U.S. media over and over in the past few years – the cost of a life-saving or maintenance drug suddenly jumps by as much as 1 000 percent, leaving patients and their advocates angry and bewildered.


Outside the US, where list prices are typically lower, research shows that Keytruda can often be far less affordable relative to income. In India, for example, one month of treatment could cost about a year of income for someone paid typical wages, research shows.

In India, one month of treatment could cost about a year of income for someone paid typical wages, research shows.

Secrecy and unequal negotiating power drive pricing

These and other important findings point to a broader and long-standing pattern in the pharmaceutical industry, the authors state, where secrecy and unequal negotiating power drive pricing. And those consequences can push some patients toward black markets in search of cheaper — though possibly dangerous — alternatives or into legal battles that can take years they don’t have.