How Merck keeps the price of its blockbuster cancer drug sky-high, shutting out patients and straining health care systems around the world.
A yearlong investigation by the International Consortium of Investigative Journalists (ICIJ) has uncovered how Merck & Co. has kept the price of its blockbuster cancer drug Keytruda extraordinarily high while deterring competition. The Cancer Calculus, an investigation by ICIJ and 47 media partners in 37 countries, also sheds new light on the strategies that have allowed Merck to widen Keytruda’s use — even in cases where its benefits are more limited and lower dosages may be just as effective. A game changer in cancer treatment, Keytruda, known generically as pembrolizumab, weaponizes a patient’s immune system against cancer cells. The U.S. Food and Drug Administration (FDA) approved it in 2014 to treat advanced melanoma, the most aggressive form of skin cancer. The FDA has since approved it for 19 types of tumors. ICIJ’s investigation found that Merck’s list prices, or the initial pre-discount prices, vary wildly across countries, ranging from about $850 for a single 100 milligram vial in Indonesia to $6,015 for the same vial in the U.S. Usually administered via intravenous infusion in 200 mg doses every three weeks or 400 mg doses every six weeks, treatment can last up to two years — amounting to a staggering $416,000 according to the drug’s list price in the U.S. — and sometimes longer, though insurance companies often stop covering the drug after the initial two years. With the cost of prescription drugs continually soaring, President Donald Trump convened top executives from major drug companies at the White House this past December and promised to lower U.S. drug prices. Among the executives was Robert M. Davis, head of Merck. All the companies pledged price cuts, but Merck made no such commitment with Keytruda, which generated $31.7 billion in 2025 — nearly half the company’s revenue. And 60% of the drug’s sales were in the U.S. Based on hundreds of interviews with oncologists, cancer patients and their families, patent experts, regulators, pharmaceutical industry insiders and others, as well as exclusive pricing data and patent analyses, together with thousands of pages of company presentations, patent board documents, lawsuits and corporate and regulatory records, and more than 1,000 public records requests in 27 countries, the Cancer Calculus investigation pulls the curtain back on precisely how Merck maintains its dominance.
How Merck keeps the price of its blockbuster cancer drug sky-high, shutting out patients and straining health care systems around the world.
A yearlong investigation by the International Consortium of Investigative Journalists (ICIJ) has uncovered how Merck & Co. has kept the price of its blockbuster cancer drug Keytruda extraordinarily high while deterring competition. The Cancer Calculus, an investigation by ICIJ and 47 media partners in 37 countries, also sheds new light on the strategies that have allowed Merck to widen Keytruda’s use — even in cases where its benefits are more limited and lower dosages may be just as effective. A game changer in cancer treatment, Keytruda, known generically as pembrolizumab, weaponizes a patient’s immune system against cancer cells. The U.S. Food and Drug Administration (FDA) approved it in 2014 to treat advanced melanoma, the most aggressive form of skin cancer. The FDA has since approved it for 19 types of tumors. ICIJ’s investigation found that Merck’s list prices, or the initial pre-discount prices, vary wildly across countries, ranging from about $850 for a single 100 milligram vial in Indonesia to $6,015 for the same vial in the U.S. Usually administered via intravenous infusion in 200 mg doses every three weeks or 400 mg doses every six weeks, treatment can last up to two years — amounting to a staggering $416,000 according to the drug’s list price in the U.S. — and sometimes longer, though insurance companies often stop covering the drug after the initial two years. With the cost of prescription drugs continually soaring, President Donald Trump convened top executives from major drug companies at the White House this past December and promised to lower U.S. drug prices. Among the executives was Robert M. Davis, head of Merck. All the companies pledged price cuts, but Merck made no such commitment with Keytruda, which generated $31.7 billion in 2025 — nearly half the company’s revenue. And 60% of the drug’s sales were in the U.S. Based on hundreds of interviews with oncologists, cancer patients and their families, patent experts, regulators, pharmaceutical industry insiders and others, as well as exclusive pricing data and patent analyses, together with thousands of pages of company presentations, patent board documents, lawsuits and corporate and regulatory records, and more than 1,000 public records requests in 27 countries, the Cancer Calculus investigation pulls the curtain back on precisely how Merck maintains its dominance.
About the Cancer Calculus investigation
The International Consortium of Investigative Journalists is proud to bring you our latest investigation: The Cancer Calculus
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