OVERVIEW
How Merck turned its wonder drug into a blockbuster — and priced out cancer patients worldwide
The pharmaceutical giant has built a fortress of patents, traded in secrecy and relentlessly lobbied to guard its revenue kingpin Keytruda.
Cancer Calculus
How Merck keeps the price of its blockbuster cancer drug sky-high, shutting out patients and straining health care systems around the world.
In this investigation
Asia-Pacific
Counterfeiters cash in on the world’s bestselling cancer drug
Desperate patients — and even hospitals — have become unwitting customers of fake Keytruda, with potentially fatal consequences.
By Nicole Sadek | April 13, 2026
INSURERS
‘They deny the medication that is keeping you alive’: Patients wage grueling legal battles for lifesaving cancer drug
As bureaucratic fights to access Keytruda drag on for years, some patients die waiting.
By Brenda Medina | April 13, 2026
About Cancer Calculus
Featured investigations
OVERVIEW
How Merck turned its wonder drug into a blockbuster — and priced out cancer patients worldwide
The pharmaceutical giant has built a fortress of patents, traded in secrecy and relentlessly lobbied to guard its revenue kingpin Keytruda.
Asia-Pacific
Counterfeiters cash in on the world’s bestselling cancer drug
Desperate patients — and even hospitals — have become unwitting customers of fake Keytruda, with potentially fatal consequences.
INSURERS
‘They deny the medication that is keeping you alive’: Patients wage grueling legal battles for lifesaving cancer drug
As bureaucratic fights to access Keytruda drag on for years, some patients die waiting.
INTERACTIVE
How Merck uses patents to help maintain Keytruda’s exorbitant price
Explore the U.S. patents Merck deploys to stymie competition and keep revenues for its blockbuster cancer drug flowing as long as possible.
Key findings
1
The Cancer Calculus found that Merck and other cancer research businesses exploited the patent system to build a fortress around Keytruda of at least 1,212 patent applications in 53 jurisdictions that could help stifle competition and maintain high prices for 14 years after the original patents expire.
2
Keytruda’s steep prices have strained government budgets, even in wealthy countries. List prices for a typical treatment range from about $80,000 a year in Germany to $208,000 in the U.S., $93,000 in Lebanon to about $130,000 in Colombia, and $65,000 in South Africa to $116,000 in Croatia.
3
Merck has used regulatory shortcuts, led a costly global lobbying campaign, and operated with a gross lack of transparency in pricing. It has distributed tens of millions of dollars in consulting fees, travel costs and other Keytruda-related payments to U.S. doctors and health-care professionals.
4
An ICIJ analysis shows that Merck has made about $163 billion in Keytruda sales since 2014, reaching more than 3 million patients.
