{"id":623397,"date":"2026-09-13T12:44:09","date_gmt":"2026-09-13T12:44:09","guid":{"rendered":"https:\/\/www.newsbeep.com\/ie\/623397\/"},"modified":"2026-09-13T12:44:09","modified_gmt":"2026-09-13T12:44:09","slug":"canada-spends-800m-on-single-cancer-drug-keytruda","status":"publish","type":"post","link":"https:\/\/www.newsbeep.com\/ie\/623397\/","title":{"rendered":"Canada spends $800M on single cancer drug Keytruda"},"content":{"rendered":"

Four years ago, Bill Lake, a retired engineer and avid beekeeper from Battersea, Ontario, was told he had incurable colon cancer<\/a>.<\/p>\n

By the time a CT scan revealed tumours had spread to his lymph nodes, doctors at Kingston General Hospital didn\u2019t think they could halt the disease.<\/p>\n

To Shari, Lake\u2019s wife of nearly 40 years, the diagnosis felt like a death sentence.<\/p>\n

\u201cWe had no hope,\u201d she said. \u201cThey gave us one year before he would be palliative.\u201d<\/p>\n

Lake started to check items off his bucket list: a trip with Shari to Newfoundland; a new pontoon boat for sunset cruises on a nearby lake; extra sleepovers with his granddaughter.<\/p>\n

Then, in late 2022, the 64-year-old was offered a second chance. Earlier that year, the Ontario government had started to fund an immunotherapy drug for his rare form of colon cancer.<\/p>\n

Called pembrolizumab, also known by its brand name Keytruda, the drug had worked wonders for patients with advanced melanoma and lung cancer, giving people years instead of just months to live. Doctors encouraged Lake to give it a shot.<\/p>\n

The immunotherapy worked. By the spring, Lake was laughing again at family jokes, and he\u2019d gone back to beekeeping, spending hours each day tending his backyard hives.<\/p>\n

\u201cThis drug,\u201d said Shari, \u201cit gave us back our hope.\u201d<\/p>\n

First approved by Health Canada<\/a> in 2015, Keytruda has revolutionized how some types of cancers<\/a> are treated, extending lives far beyond what is possible with chemotherapy and radiation.<\/p>\n

\"Bill<\/p>\n

Bill Lake, a retired engineer and beekeeper, in his backyard in Battersea, Ont., with some of his many hives. After being diagnosed with a rare form of colon cancer in 2022, Lake was afraid he\u2019d have to give up beekeeping.<\/p>\n

Sophie Bouquillon\/Toronto Star<\/p>\n

But its cost is extraordinarily steep. One year of Keytruda treatment carries an estimated sticker price of $150,000 per patient. And as the drug gets approved for a growing number of cancers, opening access to thousands more patients a year, total costs are soaring.<\/p>\n

In 2023 alone, researchers estimate that Canada spent nearly $800 million on Keytruda, based on its list price, making it the single biggest hospital drug expense in the country.<\/p>\n

\u201cOne out of every $10 spent on cancer hospital treatments is going toward this drug,\u201d said Mina Tadrous, a pharmaceutical policy researcher at the University of Toronto.<\/p>\n

\u201cFor people who manage health systems, those numbers have to be concerning.\u201d<\/p>\n

Keytruda is the world\u2019s top-selling brand pharmaceutical, generating more than $30 billion (U.S.) in sales last year alone.<\/p>\n

For Merck & Co, the New Jersey-based pharmaceutical giant behind the medication, Keytruda is nothing short of a blockbuster.<\/p>\n

But for the health-care systems writing the cheques, it has become known as a budget breaker.<\/p>\n

The investigation found the company uses a combination of patent strategies, secret pricing negotiations and relentless lobbying to maintain Keytruda\u2019s steep price around the world, pushing its annual revenues for the drug beyond those of McDonald\u2019s or the National Football League.<\/p>\n

But even as demand for Keytruda has risen, Merck has shown little interest in curbing its prices.<\/p>\n

Across five continents, the ICIJ investigation found deep inequities in who can access this life-extending medication, its cost making it inaccessible to patients in many parts of the world. That divide is exacerbated by Merck\u2019s insistence that a higher dosage should be administered per patient than experts say is necessary.<\/p>\n

Canada has been one of the few countries worldwide to secure cost savings by pushing back against Merck\u2019s aggressive dosing strategy. But the medication has still put a massive strain on health budgets.<\/p>\n

\u201cIt doesn\u2019t take a lot of economic arithmetic to start asking questions about how long we can continue to pay for these drugs,\u201d said Dr. Christopher Booth, a professor and oncologist at Queen\u2019s University who researches the financial impacts of cancer drugs on provincial health budgets.<\/p>\n

For Booth, as well as for many of the more than two dozen oncologists, economists, pharmaceutical policy experts and industry insiders interviewed for this article, drugs such as Keytruda will force the health-care system \u2014 and society at large \u2014 to confront an uncomfortable question:<\/p>\n

What other health services will we have to give up to keep spending more and more money on expensive cancer medicines?<\/p>\n

A \u2018very clever\u2019 drug mechanism<\/p>\n

Lake has a rare subtype of metastatic colorectal cancer<\/a> called MSI that affects about 15 per cent of patients.<\/p>\n

By the time he was offered Keytruda, Lake had undergone surgery to remove the portion of his bowel blocked by cancer. Five rounds of radiation had failed to shrink the tumours in the lymph nodes in his neck. He was also told the highly aggressive cancer was resistant to chemotherapy.<\/p>\n

The genetic makeup of MSI, however, left it vulnerable to Keytruda.<\/p>\n

\u201cThe drug\u2019s mechanism is very clever,\u201d said Booth, Lake\u2019s oncologist at Kingston Health Sciences Centre. \u201cKeytruda itself does nothing to the cancer cell. What it does is essentially remove the brakes on the body\u2019s immune system and unleashes it to fight the cancer.\u201d<\/p>\n

First approved for advanced melanoma, Keytruda has drastically rewritten the prognosis of the deadly skin cancer. Stage four melanoma once carried a median life expectancy of less than a year. With Keytruda, doctors now speak of 10-year survival trajectories for some patients.<\/p>\n

Booth said the drug has had similar \u201cremarkable\u201d effects on lung cancer, kidney cancer and Lake\u2019s rare subtype of colon cancer.<\/p>\n

\u201cHistorically, patients like Bill would live for a number of months or a couple of years at most and we use chemotherapy for as long as it works,\u201d Booth said. \u201cNow, when we use immunotherapy, many patients go into these prolonged remissions, where their cancers almost disappear.\u201d<\/p>\n

\"inv-keytruda-booth-solo.JPG\"<\/p>\n

Dr. Christopher Booth, a professor and oncologist at Queen\u2019s University, said drugs like Keytruda extend lives but are putting increasing pressure on health system budgets.<\/p>\n

Ian MacAlpine for the Toronto Star<\/p>\n

Since 2015, Health Canada has approved Keytruda for 35 different indications, including treating forms of breast, gastric and endometrial cancers. For these three, Booth said Keytruda\u2019s results have been more modest.<\/p>\n

Lake, whose immunotherapy schedule took him to Kingston General every three weeks, never missed an appointment for the IV infusion. He recalls no ill effects from the treatment \u2014 \u201cI just went about my normal day.\u201d He and Shari were stunned when doctors said the tumours in his lymph nodes were shrinking.<\/p>\n

\u2018Breaking point\u2019 looms for cancer drug spending<\/p>\n

As Keytruda offers new hope to patients, those who manage public health budgets have been watching \u2014 and worrying about \u2014 its cost.<\/p>\n

Not only do Keytruda and other immunotherapy drugs have high price tags, with public list prices often exceeding $100,000 (Canadian) per person per year, patients are living longer while on treatment, pushing up overall spending.<\/p>\n

Between 2010 and 2019, sales of cancer medicines in Canada tripled, climbing from $1.3 billion to $3.9 billion.<\/p>\n

By 2021, the independent federal agency responsible for monitoring and regulating the prices of patented medicines issued a stark warning over \u201cvery costly\u201d cancer therapies.<\/p>\n

\u201cThe costs associated with oncology medicines present an increasingly significant challenge to the sustainability of Canadian public drug plans nationwide,\u201d the report from the Patented Medicine Prices Review Board said.<\/p>\n

Since then, experts say budget pressures have only intensified.<\/p>\n

\u201cIt was a significant issue a decade ago. It\u2019s even more of a significant issue now,\u201d said Scott Gavura, director of Provincial Drug Reimbursement Programs at Ontario Health.<\/p>\n

In a rare interview, Gavura, whose role sits at the centre of how the province decides which cancer medicines to cover, acknowledged the rate of spending on drug treatments is a \u201csignificant pressure point\u201d for already stretched health systems.<\/p>\n

A 2024 study, which analyzed data from Ontario\u2019s cancer agency, found that cancer drug spending in the province rose from $500 million in 2012 to $1.7 billion by 2022.<\/p>\n

Booth, who led the study, said the research highlighted something even more striking: cancer drug spending increased by about 15 per cent per year, far outpacing the provincial health budget\u2019s annual growth of between 3 and 7 per cent.<\/p>\n

He said Keytruda and other types of immunotherapies are among the biggest drivers of this accelerated spending.<\/p>\n

\u201cIf we don\u2019t figure out how to make this sustainable, we\u2019re going to hit a breaking point.\u201d<\/p>\n

Gavura, a co-author of the 2024 study, agreed that ensuring costly cancer medicines don\u2019t crowd out other health-system investments is forcing difficult trade-offs.<\/p>\n

\u201cIn a cancer system, or health system, a drug is just one aspect of it. You need to have all the other pieces within the system for patients to benefit from that therapy,\u201d he said.<\/p>\n

Confidential negotiations set drug prices\u00a0<\/p>\n

There\u2019s a complicating factor in trying to answer those broader health budget questions: the secretive nature of pharmaceutical pricing.<\/p>\n

Drug manufacturers set official list prices for brand-name medicines when they come to market. But the true price paid by governments may be substantially lower, negotiated behind closed doors with drug companies. That discounted price is kept from the public.<\/p>\n

Experts who spoke to the Star called list prices arbitrary \u2014 one described them as \u201cindefensible\u201d \u2014 and said they are primarily based on a company\u2019s desired return on investment, not the drug\u2019s actual development and manufacturing cost. They also vary between countries.<\/p>\n

\"keytruda<\/p>\n

Keytruda is the world\u2019s top-selling brand drug.<\/p>\n

Ian MacAlpine for the Toronto Star<\/p>\n

In the case of Keytruda, the ICIJ investigation found significant disparities in Merck\u2019s initial prediscount prices. In Indonesia, a 100 mg vial of Keytruda is listed at $850 (U.S.), while the same vial in the U.S could be listed at $6,015.<\/p>\n

In Canada, the list price for a 100 mg vial of Keytruda is $4,400 (Canadian), according to Canada\u2019s Drug Agency, the national body that independently reviews new medicines and recommends whether provinces should fund them.<\/p>\n

In a statement, Merck Canada said it has a long history of responsibly pricing its medications \u201cto reflect their value to patients, payers and society.\u201d<\/p>\n

\u201cTo ensure our products reach as many patients as possible, we price them differentially across markets, and sometimes within markets, according to numerous factors,\u201d Merck Canada said. The company noted these factors include \u201cthe value a therapy brings to patients and the health-care system, countries\u2019 pricing and reimbursement systems and the ability of governments to finance health-care.\u201d<\/p>\n

Secret deals benefit pharma industry, experts say<\/p>\n

In general, Canada has some of the highest pharmaceutical list prices in the world, ranking fifth among 31 OECD countries, according to the Patented Medicine Prices Review Board. Tadrous, the U of T policy expert, said list prices, while inflated, represent the starting point for confidential negotiations between drug companies and governments.<\/p>\n

\u201cYou hope in the back-and-forth that they can end up somewhere in the middle,\u201d said Tadrous, who holds a Canada Research Chair in pharmaceutical policy and real-world evidence. He said these \u201cblack box\u201d deals are not simple price cuts, but involve complex rebate structures, including volume-based discounts.<\/p>\n

\u201cThen that price is locked up in a vault and kept secret from everybody.\u201d<\/p>\n

Many pharmaceutical policy experts say Canada\u2019s drug-funding process does appear to deliver deep price reductions. The pan-Canadian Pharmaceutical Alliance, which negotiates drug prices on behalf of provinces and territories, said it brokered more than $5 billion in discounts last fiscal year.<\/p>\n

Still, other experts argue that if a critical drug like Keytruda starts off with a sky-high list price, governments will struggle to reach a fair public payer cost; the price gap is just too wide.<\/p>\n

They also say the secrecy built into the system benefits drug companies, allowing them to maintain their negotiating power in Canada and other countries while also protecting the much-larger U.S. market.<\/p>\n

Merck Canada said it rejects suggestions that its \u201capproach to intellectual property undermines access,\u201d adding that \u201cprotecting innovation is a necessary part of developing new medicines and sustaining the long-term research needed to bring future treatments to patients.\u201d<\/p>\n

The company noted that Keytruda is \u201cone of the largest pharmaceutical R&D programs ever undertaken, with more than 2,800 clinical trials worldwide.\u201d\u00a0<\/p>\n

Douglas Clark, an Ottawa-based pharmaceutical industry consultant, said private companies take on huge risk in developing new drugs and have a right to make a profit. He said it\u2019s also true that governments are finding it increasingly difficult to make room in their budgets for high-cost drugs like Keytruda, even with negotiated discounts.<\/p>\n

That tension, said Clark, a former executive with both the pan-Canadian Pharmaceutical Alliance and the Patented Medicine Prices Review Board, is especially heightened for drugs that can save or extend lives.<\/p>\n

\u201cAt its best the industry does God\u2019s work, bringing breakthrough cures to market for conditions that until recently amounted to a death sentence, but that can\u2019t serve as a licence to charge the devil\u2019s price, such that no one can afford it.\u201d<\/p>\n

Canada pushes back on Keytruda pricing with weight-based dosing<\/p>\n

Beyond negotiated discounts, Canada has taken further \u2014 and much bolder \u2014 steps to cut Keytruda costs. It\u2019s among just a handful of countries to push back against Merck\u2019s dosing guidelines for Keytruda, adopting a strategy that allows for dosing patients according to their weight.<\/p>\n

This means many Canadian patients receive a lower dose of Keytruda than what the company currently recommends, leading to cost savings for the system.<\/p>\n

Canada\u2019s move is backed by Merck\u2019s own scientific evidence. The company\u2019s original clinical trials showed Keytruda was safe, effective and extended lives when patients were dosed by weight.<\/p>\n

But starting in 2016, Merck moved to a fixed, 200-mg dose for adult patients, meaning every patient, no matter their weight, would be given the same amount of Keytruda.<\/p>\n

The company has stated a fixed dose is simpler to prescribe and reduces the risk of dosing errors, while providing the same clinical benefit as weight-based dosing.<\/p>\n

But according to six experts who spoke to the Star, Merck\u2019s fixed dose is likely an overestimate, giving many patients more than they need. Many also said Merck likely adopted fixed dosing with Keytruda to maximize company profits.<\/p>\n

\u201cIf you step back and look at the financial responsibilities of a corporation, it\u2019s to generate the largest profits,\u201d said Booth. \u201cAnd if you take that one step further in the pharmaceutical industry, that means it\u2019s really about selling as much drug as you can, at the highest possible price, for the most patients, for the longest duration.\u201d<\/p>\n

In a statement, Merck Canada rejected this characterization, stating that it \u201cmisrepresents the integrity of our research, our pricing practices, or our commitment to patients.\u201d<\/p>\n

The company stated it has determined the optimal dose and treatment duration of Keytruda through extensive clinical trials.<\/p>\n

The company went on to say that it \u201ccannot be assumed that weight-based doses that have not been thoroughly studied would have the same therapeutic effect as the label-recommended fixed doses.\u201d<\/p>\n

According to the ICIJ, the Netherlands and Israel have moved to weight-based dosing, and research is underway in India to see if even lower doses can benefit patients. The investigation pointed to a World Health Organization modelling projection that found the world could save $5 billion (U.S.) by 2040 if lung cancer patients received Keytruda based on their weight instead of using Merck\u2019s fixed dose.<\/p>\n

Matthew Herder, a health law expert and professor of pharmacology at Dalhousie University, said while there is strong clinical and economic evidence backing Canada\u2019s decision to prescribe Keytruda by a patient\u2019s weight, it\u2019s also a \u201cBand Aid solution\u201d to minimize the budget impact of such a high-cost drug.<\/p>\n

\"Bill<\/p>\n

Bill and Shari Lake in their kitchen, almost two years since Lake\u2019s final dose of Keytruda.<\/p>\n

Sophie Bouquillon\/Toronto Star<\/p>\n

Instead, Canada should be pushing for broader system reforms to bring down the list prices of brand-name medicines that drug companies set for the country. The ceiling price to even start discount negotiations is far too high, Herder said.<\/p>\n

\u201cAll of the evidence we\u2019ve got, in every country that\u2019s looked at this properly, is that these drugs are priced at levels where they displace multiple times more health than they produce.\u201d<\/p>\n

\u2018The reason I\u2019m still here\u2019<\/p>\n

Sitting at his kitchen table, the sun streaming in through the patio door, Lake is startled to learn the list price for Keytruda.<\/p>\n

He knew the drug was expensive but not that each of his 35 infusions had an estimated sticker price of almost $12,000 (Canadian).<\/p>\n

When Shari shows him her quick calculation for two years of Keytruda treatment \u2014 more than $400,000 at the pre-discounted price \u2014 Lake leans back in his chair and lets out a long sigh.<\/p>\n

\"Bill<\/p>\n

Bill Lake\u2019s notebook.<\/p>\n

Sophie Bouquillon\/Toronto Star<\/p>\n

Shari just smiles: \u201cHe\u2019s worth it.\u201d<\/p>\n

Booth is just as pleased that breakthrough medicines like Keytruda are extending his patient\u2019s lives.<\/p>\n

He stressed that tough conversations about high-cost cancer therapies isn\u2019t to make patients feel guilty. Instead, the scrutiny should be on the drug companies that set prices.<\/p>\n

\u201cDelivering a treatment that has such a radical impact on a patient\u2019s life is one of the things that drew all of us into oncology,\u201d Booth said. \u201cWe want to see more effective treatments like this developed \u2014 and be able to have a health system be able to pay for them.\u201d<\/p>\n

It\u2019s been almost two years since Lake\u2019s final dose of Keytruda and he remains in remission. He\u2019s spent much of this summer with his bees, already harvesting 900 kg of honey.<\/p>\n

A left over habit from his days as an engineer, Lake stashes a small notebook in the breast pocket of his shirt. He uses it to keep track of his bee colonies and honey business, but also to jot down dates for birthdays, bank account numbers and any other detail he wants to keep fresh in his mind.<\/p>\n

Lake has written \u201cpembrolizumab\u201d \u2014 Keytruda\u2019s pharmaceutical name \u2014 on the inside cover.<\/p>\n

\u201cI need help remembering how to spell that,\u201d he said with a laugh. \u201cIt\u2019s the reason I\u2019m still here.\u201d<\/p>\n

With files from Amy Dempsey Raven (Toronto Star), Sydney P. Freedberg, Brenda Medina and Denise Ajiri (ICIJ)<\/p>\n","protected":false},"excerpt":{"rendered":"Four years ago, Bill Lake, a retired engineer and avid beekeeper from Battersea, Ontario, was told he had…\n","protected":false},"author":2,"featured_media":623398,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[33],"tags":[103,61,60,371],"class_list":["post-623397","post","type-post","status-publish","format-standard","has-post-thumbnail","category-medication","tag-health","tag-ie","tag-ireland","tag-medication"],"_links":{"self":[{"href":"https:\/\/www.newsbeep.com\/ie\/wp-json\/wp\/v2\/posts\/623397","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.newsbeep.com\/ie\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.newsbeep.com\/ie\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/ie\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/ie\/wp-json\/wp\/v2\/comments?post=623397"}],"version-history":[{"count":0,"href":"https:\/\/www.newsbeep.com\/ie\/wp-json\/wp\/v2\/posts\/623397\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/ie\/wp-json\/wp\/v2\/media\/623398"}],"wp:attachment":[{"href":"https:\/\/www.newsbeep.com\/ie\/wp-json\/wp\/v2\/media?parent=623397"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.newsbeep.com\/ie\/wp-json\/wp\/v2\/categories?post=623397"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.newsbeep.com\/ie\/wp-json\/wp\/v2\/tags?post=623397"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}