The international Cancer Calculus investigation has placed the price of cancer medicines, and the secrecy surrounding those prices, under renewed public scrutiny. Led by the International Consortium of Investigative Journalists (ICIJ), the year-long investigation examined Keytruda, the immunotherapy known generically as pembrolizumab. Keytruda has transformed treatment for many patients, but its price and market position also illustrate the tension between rewarding innovation, ensuring access and protecting the sustainability of collectively financed healthcare systems.

A global investigation into one medicine

Cancer Calculus brought together 124 journalists from 48 newsrooms. Reporters filed more than 1,000 public-record requests in 27 countries and combined pricing information, patent records, court files and interviews with patients, clinicians, regulators and pharmaceutical experts. The investigation describes how prices vary widely between countries while the actual prices paid by health systems often remain hidden behind confidential discounts and rebate agreements.

ICIJ also reported that the patent portfolio surrounding Keytruda includes more than 1,200 applications across 53 countries, regions and territories. Follow-on patents may extend market exclusivity beyond the expiry of the original patents. The investigation further examined dosing practices, lobbying and the consequences of high prices for public budgets and individual patients. Merck, the manufacturer, defended its pricing approach to ICIJ, stating that it seeks to reflect the medicine’s value to patients, payers and society. This response is an important part of the debate, but it does not remove the need for verifiable evidence and public accountability.

Why transparency matters for patients and payers

Confidential discounts can appear to give purchasers a better deal, but widespread secrecy also fragments the market. A health authority negotiating a price may not know what comparable countries or institutions pay. This weakens the ability of public purchasers and non-profit payers to benchmark offers, identify unjustified differences and negotiate on equal terms. It also makes democratic oversight of public and collectively financed spending more difficult.

The Austrian reporting provides a striking example. Journalists reported a list price of around EUR 6,800 for a standard 200-milligram dose of Keytruda, before confidential discounts. A calculation based on AIM’s fair-pricing approach indicated a price of roughly EUR 80 per dose. These figures are not directly comparable to every confidential transaction, and they should not be read as a claim that all costs are identical in every setting. They nevertheless illustrate the scale of the questions facing health systems when prices cannot be explained through transparent assumptions.

Access problems also create risks beyond delayed or denied treatment. ICIJ partners documented counterfeit markets and unsafe supply routes in countries where patients could not afford authorised products. Fair and transparent pricing is therefore connected not only to public budgets, but also to patient safety and confidence in legitimate supply chains. When essential treatment is priced beyond reach, vulnerable people may be pushed towards dangerous alternatives.

A practical approach to fair pricing

AIM’s Fair Pricing Model starts from a simple principle: a medicine’s price should recognise genuine research, development and production costs, provide a reasonable profit and take account of added therapeutic value, while remaining affordable for patients and health systems. The accompanying Fair Pricing Calculator makes those assumptions visible. It is intended as a negotiation and policy tool rather than a substitute for health technology assessment or country-specific reimbursement decisions.

Recent peer-reviewed research applying the AIM model to ten market-protected medicines across six European countries found substantial differences between observed expenditure and modelled fair prices. The study estimated that wider use of fairer prices could save the EU up to EUR 27 billion annually. This evidence strengthens the case for systematic scrutiny of prices, especially where medicines benefit from public research support, regulatory incentives, long exclusivity periods or limited competition.

From investigation to policy action

Investigative journalism cannot set medicine prices, but it can make complex systems understandable and reveal where information gaps frustrate accountability. Its work complements the efforts of researchers, patient organisations, clinicians and healthcare payers. The Cancer Calculus reporting has already generated political and legal follow-up in several countries, demonstrating that transparency questions are not abstract: they influence budgets, treatment decisions and trust in health policy.

AIM will continue calling for stronger public negotiating capacity, earlier and more effective competition, appropriate scrutiny of patent strategies, and access to reliable information about prices and public investment. Innovation and access should reinforce one another. Patients benefit when effective medicines reach them quickly, but they also depend on health systems that can finance prevention, staff, primary care and future treatments. Fair pricing is therefore not only a pharmaceutical-policy issue; it is a condition for solidarity and sustainable access to care.