Merck’s Keytruda: A lifesaving drug, a global divide

The Investigation Unveils a Health Paradox

A joint investigation by Deutsche Welle and the International Consortium of Investigative Journalists (ICIJ) reveals how pricing and patent strategies have transformed a groundbreaking cancer treatment into one of the most lucrative drugs globally, while leaving many patients unable to afford it. This yearlong study, titled The Cancer Calculus, involved 124 journalists across 37 nations, uncovering how medical advancements have created stark inequalities in access to life-extending therapies.

Through hundreds of interviews and exclusive data from 1,018 public records requests in 27 countries, the project highlights the role of pricing systems, regulatory frameworks, and patent protections in determining who benefits from Keytruda. Partners such as The Indian Express, De Tijd, and DW Turkish documented how the drug’s impact varies dramatically from country to country.

“Merck’s strategies have turned Keytruda into a symbol of unequal access,” said one reporter, summarizing the findings.

A Breakthrough with a Price Tag

Keytruda, known as pembrolizumab, is a revolutionary immunotherapy drug first approved in 2014. Now used for at least 19 tumor types, it has extended survival for millions and transformed fatal diagnoses into manageable conditions. Yet, its commercial success has exacerbated a divide between those who can afford it and those who cannot.

The drug’s global sales reached $31.7 billion in 2025—nearly half of Merck’s total revenue—and totaled around $163 billion since its launch. The United States accounts for 60% of these sales, despite the country’s high treatment costs, which can exceed $208,000 annually. Meanwhile, Merck has distributed $75 billion in dividends and $43 billion into share buybacks.

Expanding Markets, Widening Gaps

Merck’s market expansion has surged in recent years, with sales in France rising 232% to $2.8 billion, Brazil seeing a 265% increase to $753.7 million, Mexico growing by 491% to $137.3 million, and Turkey climbing 584% to nearly $100 million. These figures underscore the uneven distribution of medical benefits across regions.

Healthcare systems worldwide face mounting strain from escalating drug costs. In Germany, annual treatment costs hover around $80,000, while in the U.S., they exceed $208,000. Lebanon and Colombia see prices of $93,000 and $130,000 respectively, and even in wealthier nations like South Africa and Croatia, costs range from $65,000 to $116,000. In the UK, research found the National Health Service overpaid for Keytruda in some cases, with one study noting it cost up to five times its assessed value for certain lung cancer patients.

Patent Power and Regulatory Influence

The investigation found Merck leverages a blend of legal and commercial tactics to sustain its market dominance. Central to this is its aggressive use of patent systems, with over 1,212 applications filed across 53 jurisdictions. While the drug’s core patents expire in 2028, follow-on patents could extend exclusivity until 2042, delaying cheaper alternatives for over a decade.

Critics describe this as a “patent fortress” designed to stifle competition. Merck counters that these filings reflect ongoing innovation, including new formulations and uses. The report also highlights regulatory pathways and lobbying efforts that expanded Keytruda’s applications, alongside financial ties to doctors and patient advocacy groups. In the U.S. alone, Merck made nearly $52 million in payments to healthcare professionals between 2018 and 2024.