Drug patents are meant to help pharmaceutical companies recoup high development costs by preventing competitors from using the intellectual property for a defined period of time, typically 20 years in the U.S.

But the global patent system — a patchwork of national laws loosely connected by international treaties — is vulnerable to manipulation. In the case of Keytruda, a blockbuster cancer drug, companies exploited the patent system to try to extend market exclusivity well beyond the expiration of the drug’s initial patents, keeping competitors at bay and prices artificially high for years. Prolonged patent monopolies can delay cheaper alternatives entering the marketplace, prioritizing profit over patient access, straining governments’ healthcare budgets and putting patients’ health — sometimes even their lives — at risk.

For its Cancer Calculus project, the International Consortium of Investigative Journalists tracked Keytruda-related patents to show how Merck & Co. and other pharmaceutical companies created a dense web of patent applications that can make it harder for more affordable versions of the drug, known as biosimilars, to enter markets around the world. Merck, known as MSD outside the U.S. and Canada, did this by applying for patents for changes to formulation and dosing regimens, altering the drug’s use in combination with other agents, or for switching patients to a similar, newer version of the same drug — known as a “product hop.” Each change can potentially reset the patent clock and add years of exclusivity.

Merck’s scramble to fortify its dominance has included filing for patents that are combinations of Keytruda and another medication that aren’t necessarily new or innovative, according to experts interviewed by ICIJ.

Even if a patent isn’t ultimately approved by a patent office, the application itself can increase the complexity of the competitive landscape, creating legal and commercial uncertainty that can delay or deter competitors, patent experts said.

Patents were only part of the data that explains Keytruda’s price dominance and patients’ struggles to cope with it. ICIJ also reviewed the prices of Keytruda (known generically as pembrolizumab) across dozens of countries. Those prices can vary wildly depending on location and medical context — the result of opaque negotiations between governments and Merck. We also reviewed lawsuits and other court documents filed in Latin America to track the rising number of patients fighting in court, regulatory bodies and elsewhere to gain access to Keytruda, a trend due, in part, to its high prices. Researchers in the region see the phenomenon as part of an increasing judicialization of healthcare.

https://www.icij.org/investigations/cancer-calculus/merck-keytruda-cancer-drug-price/

OVERVIEW How Merck turned its wonder drug into a blockbuster — and priced out cancer patients worldwide Apr 13, 2026

https://www.icij.org/investigations/cancer-calculus/keytruda-evergreening-patents-merck/

INTERACTIVE How Merck uses patents to help maintain Keytruda’s exorbitant price Apr 13, 2026

https://www.icij.org/investigations/cancer-calculus/cancer-drug-counterfeits-keytruda-immunotherapy/

COUNTERFEITS Counterfeiters cash in on the world’s bestselling cancer drug Apr 13, 2026

Recommended reading OVERVIEW How Merck turned its wonder drug into a blockbuster — and priced out cancer patients worldwide Apr 13, 2026 INTERACTIVE How Merck uses patents to help maintain Keytruda’s exorbitant price Apr 13, 2026 COUNTERFEITS Counterfeiters cash in on the world’s bestselling cancer drug Apr 13, 2026

a-related” patents rather than attributing them solely to Merck.

View embedded content

Of the total 1,212 identified applications, most were assigned to Merck as of early 2026 — sometimes with co-applicants: 590, including subsidiaries or companies later acquired by Merck; 44 assigned to Ono Pharmaceutical; 45 assigned to other entities not affiliated with Merck; and 533 listed with no identified current assignee. Of the 533, 455 had originally been filed or co-filed by Merck (or by subsidiaries or companies later acquired by Merck); 14 were filed by Ono; and 34 were not related to Merck. ICIJ couldn’t determine the assignee for 30 of the applications. All applications included in ICIJ’s dataset are part of patent families related to Keytruda.

ICIJ relied on the date that an application was filed rather than the publication date to reflect when inventions were first formally claimed, which was most relevant to our analysis.

ICIJ included patents across all relevant legal statuses, including 211 granted, 337 pending, 120 abandoned, 24 ceased, 41 expired, six revoked, 75 withdrawn, and 398 whose status we couldn’t determine, to capture the full global landscape of patents related to Keytruda that fall within patent families identified by the European Patent Office. Including all statuses allows ICIJ to capture not only enforceable rights, but also the broader ecosystem shaping access and competition. Pending applications may, if granted, translate into enforceable rights with defined expiration dates. Abandoned applications, while no longer pursued, can still be used as evidence to restrict what others can patent.

While this analysis focuses on Keytruda, similar patenting strategies are common across the pharmaceutical industry. As such, the dynamics highlighted in this dataset reflect broader structural features of the global patent system, which is administered through national and regional offices, such as the U.S. Patent and Trademark Office and the European Patent Office, and linked through international frameworks like the World Intellectual Property Organization. A published patent application or successful defense in major markets can deter competitors from entering other countries where there are patents for the same invention.

 

Patent data tools

ICIJ’s use of Espacenet and Google Patents as patent data sources presented different challenges. While Espacenet blocks automated compilation of patents data, which made it difficult to extract and use for analysis, Google Patents data can be compiled using Google Big Query service. But compiling bigger datasets from there can be costly, so we confirmed that Google Patents allowed us to retrieve information about our target list of patents in an automated and careful way. We also collected some data manually to populate our analysis spreadsheet before fact-checking.

Both sources returned hard-to-read webpage content that is tricky to transform into a structured format, a task made even more difficult by the many properties a patent can contain. At this stage, ICIJ used AI large language models to generate code in the easy-to-read Python language, which used popular Python libraries (pre-existing collections of code) to create parsers that transformed the content we extracted into a single, structured spreadsheet. Two of the Python libraries were Beautiful Soup, which selects the pieces from messy HTML, and pandas, which is used for data analysis.  We then used this dataset for the patent analysis.

ial in the U.S. Extreme disparities stem from secret negotiations leading to non-public discounts and rebates applied to list prices in different countries as well as the different ways healthcare systems decide drug costs. At least half a dozen governmental authorities around the globe refused to disclose to ICIJ and our media partners public spending details about Keytruda or the number of patients receiving the medicine.

The lack of transparency around Keytruda prices presented a particular challenge. Some  pricing data, as in South Africa, is readily accessible because governments publish how much patients should expect to pay for the drug (before the cost of additional services). In Europe, by contrast, it’s often only undiscounted list prices that are published — so-called ex-factory prices, set by the manufacturer prior to negotiations with governments. So while much information is available, it’s not always the same type.

ICIJ relied on the pricing data that authorities make public as well as data gathered by its media partners. Publicly available prices — found in South Africa, in Latin America and elsewhere — correspond to different situations and kinds of transactions. For example, the minimum and maximum prices a patient can expect to be charged for a vial of the drug, or the price pharmacies report. ICIJ used list prices when available to calculate a standard price per 100 mg vial, standard 200 mg dose, and one year of treatment. This enabled us to show price differences across countries. But because list prices aren’t the actual prices paid either by governments or patients, ICIJ also studied the affordability of the drug across dozens of countries.

For European countries, ICIJ obtained list prices from the Austrian National Public Health Institute (GÖG), which gathered and calculated the price data in national currency units (unweighted raw data) from national databases as part of its Pharma Price Information service. In the case of Latin American countries and South Africa, ICIJ relied on data publicly disclosed or obtained by partners. We then converted the list prices to U.S. dollars and calculated the so-called purchasing power parity rates to account for differences in price levels across countries. Purchasing power parity helps calculate how much of a local currency is required to buy a product in the domestic market that an equivalent amount of dollars would buy for the same amount in the U.S. To calculate how many vials of Keytruda a patient in these countries could afford, we divided the median annual gross earnings there by the price per Keytruda vial in that country and adjusted for purchasing power parity. For earnings data, we used a dataset known as ILOSTAT produced by the International Labour Organization.

ICIJ analyzed Keytruda-related data from around the world for its Cancer Calculus investigation. Image: Kena Betancur/Getty Images

Counting legal battles

Keytruda has become a symbol of a dysfunctional global system that disproportionately hurts poorer countries with limited healthcare budgets and little negotiating power with Big Pharma.

Data analyzed by ICIJ shows that health and legal systems are increasingly intertwined in some Latin American countries, where thousands of cancer patients have gained access to Keytruda only through a court order after public health institutions and private insurers had denied coverage of the high-cost drug. We gathered court rulings regarding Keytruda coverage over several years from three Latin American countries: Guatemala, Mexico and Chile. (Data from Mexico and Chile was shared by ICIJ partners).

ICIJ created a database for each country based on information available in the court rulings, such as the name of the patient, defendants, dates of amparo lawsuits (a legal action designed to protect constitutional rights from abuses by the state) and court rulings, Keytruda and other drug coverage, name of the court, and final decision.

We eliminated both duplicates and court rulings not related to Keytruda, and ended up with details for 163 court rulings regarding Keytruda coverage in Guatemala (96), Mexico (55) and Chile (12). The vast majority of the rulings were  in favor of patients: 95 out of 96 in Guatemala, 36 out of 55 in Mexico and 10 out of 12 in Chile.

Through these analyses, ICIJ aimed to contextualize the central issues exposed in its Cancer Calculus investigation, detailing how Merck uses patents to keep its dominance over the drug and dispelling the secrecy that surrounds drug pricing. In this way, we sought to illustrate the plight of thousands of patients in countries where the medication is either unaffordable or inaccessible, while exposing long-held practices that have made the healthcare industry, for far too many, a broken system.

Bitcoin ATMs, the now-ubiquitous machines in gas stations and smoke shops that convert physical cash to cryptocurrency, are in trouble.

Over the past few months, the Canadian government announced a proposal to ban the scam-prone machines while Tennessee, Minnesota and Indiana passed legislation to outlaw them. Just last week, the world’s largest operator of these ATMs, Bitcoin Depot, filed for bankruptcy, citing litigation and government action. Experts and authorities have for years warned about the machines’ heavy use by criminals, who rely on them as a convenient means to collect funds from scam victims.

But as the crackdown on crypto ATMs widens, one critical aspect of the scam ecosystem has escaped scrutiny: the crypto giants that have enabled these ATM operations through massive transfers of bitcoin. Because these machines often take in cash and convert that cash to bitcoin, the crypto necessary to make such conversions are essential to the ATM firms.

At ICIJ’s request, a group of cryptocurrency investigators traced billions of dollars in bitcoin transfers from brand-name crypto firms directly to the coffers of ATM companies, even as authorities issued increasingly dire warnings about potential criminal activity. ICIJ found that after attorneys general in Massachusetts, Iowa and Washington, D.C., alleged that top ATM operators were dealing heavily in scam transactions, major crypto companies continued selling them big sums of bitcoin.

This included U.S.-based exchange Kraken, which has transferred at least $1.1 billion worth of bitcoin to crypto ATM operators in recent years. ICIJ found that Kraken sent the ATM operator Athena Bitcoin at least $17 million worth of cryptocurrency after District of Columbia authorities singled out its machines last September.

“Athena’s bitcoin machines have become a tool for criminals intent on exploiting elderly and vulnerable District residents,” D.C. Attorney General Brian Schwalb said in a statement at the time. “Athena knows that its machines are being used primarily by scammers yet chooses to look the other way.”

Athena Bitcoin has rejected these allegations. In response to questions from ICIJ, Kraken said that it takes its regulatory obligations seriously and maintains robust compliance controls. In a statement, a spokesperson said its “business relationships are subject to rigorous onboarding, ongoing due diligence, and enhanced monitoring standards.”

Between May 2020 and March 2025, the crypto firm Gemini provided more than half a billion dollars in bitcoin to Bitcoin Depot. Cumberland DRW, a crypto trading firm founded by billionaire Don Wilson, has also been a major supplier of bitcoin to crypto ATM firms, including Bitcoin Depot and CoinFlip, according to blockchain researchers.

Cumberland and Gemini did not respond to requests for comment.

A police lieutenant disconnects a Bitcoin Depot ATM inside a convenience store in Haverhill, Mass., on April 6, 2026. Image: Jessica Rinaldi/The Boston Globe via Getty Images

In some cases, big crypto players provided bitcoin to ATM operators that were later criminally charged, ICIJ found. For instance, the crypto exchange Bitstamp sent at least $7 million to a firm called Crypto Dispensers between 2018 and 2024 — which fell within a timeframe when the firm used its ATM network for money laundering, according to a federal indictment.

Bitstamp did not respond to requests for comment. Firas Isa, the founder of Crypto Dispensers, who is also under indictment for money laundering, told ICIJ in an interview that Bitstamp performed rigorous audits on his firm. Isa denies the allegations in the indictment, which states that his firm received large amounts of money derived from crimes including from scam victims.

At ICIJ’s request, a half-dozen experts who specialize in analyzing bitcoin transaction records on the public ledger known as the blockchain helped examine and confirm details of these transactions. These experts included Fred Buret, of the crypto investigations firm Recoveris, and Joshua Cooper-Duckett of the firm Cryptoforensic Investigators.

Jason Ghetian, a former FBI agent specializing in crypto scams, told ICIJ that the providers of large amounts of bitcoin to crypto ATMs should have been wary of those business relationships, given the machines’ reputation for being heavily used by criminals. “These exchanges could shut these ATMs down if they don’t provide liquidity for them,” Ghetian said.

The companies have not, however, broken the law by providing the ATMs with bitcoin liquidity. In recent years, the crypto industry’s biggest players have vigorously sought to be accepted as part of the mainstream financial system, with Kraken just this year being the first to receive approval for a so-called master account with the Federal Reserve. Even amid this push for broader recognition, the most prominent crypto firms remain deeply entwined with a part of the industry that lawmakers around the world are scrambling to protect consumers from.

https://www.icij.org/investigations/coin-laundry/crypto-atm-operator-bitcoin-depot-files-for-bankruptcy/

cryptocurrency Crypto ATM operator Bitcoin Depot files for bankruptcy May 19, 2026

https://www.icij.org/investigations/coin-laundry/retailers-keep-cashing-in-on-crypto-atms-as-scams-surge/

CRYPTOCURRENCY Retailers keep cashing in on crypto ATMs as scams surge Dec 17, 2025

https://www.icij.org/investigations/coin-laundry/massachusetts-sues-bitcoin-depot-alleging-the-crypto-atm-operator-knowingly-facilitated-crypto-scams/

IMPACT Massachusetts sues Bitcoin Depot, alleging the crypto ATM operator knowingly facilitated crypto scams Feb 26, 2026

Recommended reading cryptocurrency Crypto ATM operator Bitcoin Depot files for bankruptcy May 19, 2026 CRYPTOCURRENCY Retailers keep cashing in on crypto ATMs as scams surge Dec 17, 2025 IMPACT Massachusetts sues Bitcoin Depot, alleging the crypto ATM operator knowingly facilitated crypto scams Feb 26, 2026

I couldn’t eat, I could not sleep. It was like, how can people be so cruel? — crypto ATM scam victim Ann Tatem

Tatem had joined thousands of Americans who have collectively lost hundreds of millions of dollars to sophisticated scammers relying on ATMs to rapidly convert victims’ cash into cryptocurrency. In all of these crimes, law enforcement has little chance of tracing the cryptocurrency to an owner.

“That was a lot of our savings. We’re simple people,” Tatem said, adding that the crime left her traumatized. “I couldn’t eat, I could not sleep. It was like, how can people be so cruel? It’s just beyond my comprehension.”

 

A ‘silent partner to many scammers’

Over the past six months, the state of Connecticut suspended Bitcoin Depot’s banking license for lapses in anti-money laundering controls; Missouri’s attorney general opened an investigation into several crypto ATM operators, including Bitcoin Depot; and Nevada and Maine settled enforcement actions with the firm, requiring it to pay fines and comply with state rules. Massachusetts’ attorney general also recently sued Bitcoin Depot, alleging most of its revenue was derived from scams.

Another major sender of cryptocurrency to Bitcoin Depot was Cumberland DRW, the crypto arm of the Chicago-based trading firm DRW, founded by billionaire and famed trader Don Wilson. He made headlines last year when DRW invested $100 million into a Trump family crypto project shortly after the U.S. Securities and Exchange Commission dropped an investigation into Cumberland, according to the Financial Times. In a March filing, Bitcoin Depot named Cumberland, Gemini and other firms as its bitcoin suppliers.

Even after Gemini appeared to stop sending funds to Bitcoin Depot in March 2025, Cumberland continued to do so, according to experts who reviewed the transactions. These transactions lasted until March 30, 2026.

According to the experts ICIJ consulted, Cumberland is also a key provider of cryptocurrency to CoinFlip, which has been identified as the world’s second-largest bitcoin ATM operator behind Bitcoin Depot. Iowa’s attorney general sued CoinFlip last year, alleging that all of its top 20 crypto ATM users in Iowa, among many others, were scam victims.

An alert about bitcoin machine-related scams is included in a printed warning for staff in a Circle K convenience store.

“At best, CoinFlip is a willfully blind participant in the victimization of hundreds of Iowans,” according to the state’s lawsuit. “At worst, it is a silent partner to many scammers preying on Iowans.”

CoinFlip did not provide comment for this story. In an April filing, the firm’s lawyers said Iowa authorities have deployed baseless accusations in a “smear campaign” that has damaged its standing with regulators, legislators, consumers and business partners. The firm has denied that it enables or tolerates scammers on its machines and called the Iowa suit an “unmistakable assault on the nature of cryptocurrency itself.” CoinFlip said it requires its customers to read multiple fraud-related warnings and disclaimers when using its machines.

In recent years, Cumberland has sent CoinFlip over a billion dollars worth of bitcoin, according to experts who reviewed the transactions. These transactions were as large as $5 million apiece, the experts said.

Until mid-2024, CoinFlip also received roughly $1.5 billion worth of bitcoin from London-based trader Enigma Securities, according to the experts. Enigma Securities is a subsidiary of the Makor Group. Like Cumberland, Enigma Securities labels itself as a so-called crypto liquidity provider, giving businesses fast access to wholesale portions of various cryptocurrencies. Crypto ATMs have been effectively banned from operating in the United Kingdom because authorities have not granted a licence to any of the firms.

Enigma Securities did not respond to requests to comment on this story.

a crypto trading company headquartered in San Mateo, California. Meraban said he used accounts with multiple exchanges so that he could shop around for the cheapest bitcoin to improve his profit margins.

“We needed a lot of bitcoin and were linked up to exchanges to get that bitcoin every day,” said Meraban, who pleaded guilty in 2023 to charges relating to his firm’s licensing. “This is how the business model works.”

Enigma Securities did not respond to requests for comment. FalconX declined to provide  comment for this story.

ICIJ found that Kraken has played a key role in supplying bitcoin to several major crypto ATM operators in recent years, including more than $700 million in bitcoin to Coinhub and at least $245 million in bitcoin to Byte Federal, according to experts who reviewed these transactions.

Coinhub did not respond to a request for comment. In an interview with ICIJ, Byte Federal’s CEO Paul Tarantino said Kraken is the firm’s sole liquidity provider. “We have a really good relationship with Kraken,” he said.

Tarantino said that Byte Federal is a leader in anti-fraud measures. In early 2024, he said, Byte Federal began rigorously vetting all customers over the age of 60, resulting in 84% of those would-be customers being blocked due to scam concerns. He added that the number of those visitors to his company’s machines has recently fallen, however. “Scammers that get ahold of these seniors are making a decision not to send them to our kiosks.”

Kraken’s relationship with Athena Bitcoin, another top crypto ATM operator, appears to have expanded in late 2023. The exchange began sending the firm more than a million dollars worth of bitcoin each week on average until mid-2025, when the pace slowed, according to the experts.

Last September, Washington D.C.’s attorney general alleged that 93% of Athena Bitcoin’s transactions involved a scam, saying the firm “fails to provide effective oversight, creating an unchecked opportunity for illicit international fraud.”

An Athena Bitcoin ATM in Phoenix, Arizona. Image: Dominic Valente/Bloomberg via Getty Images

Following the legal action, Athena Bitcoin told a local news station that it “strongly disagrees with the allegations” and that it will fight the charges. The firm said it has “multiple safeguards, from prominent warnings and daily transaction limits to five separate verification screens designed to stop coerced transactions,” according to the report.

The day after the D.C. attorney general’s announcement, a Kraken account sent Athena more than $270,000 worth of bitcoin in a single transaction, according to experts ICIJ consulted. And Kraken accounts continued to send large amounts of cryptocurrency to Athena Bitcoin, amounting to about $17 million as of March 31, 2026, when the transfers appear to have stopped, the experts said.

Athena did not respond to requests to comment for this story. In a March filing, Athena Bitcoin called Kraken its “primary crypto exchange.” In a subsequent filing dated May 14, Athena did not mention Kraken.

In March, Kraken became the first crypto firm approved for a Federal Reserve master account, which allows the exchange to move traditional money directly via U.S. central banking infrastructure, a privilege never before granted to a crypto firm. Republican Sen. Cynthia Lummis of Wyoming, a proponent of the crypto industry, called the approval a “watershed moment for the digital asset industry” and a “monumental step towards making payments safer, faster, and cheaper.”

Last month, the FBI released new figures showing that crypto ATM scams had recently surged, with Americans losing $389 million relating to the machines in 2025. These scams especially targeted Americans over 60, like Ann Tatem.

Tatem told ICIJ that the loss of retirement savings forced her to cash out her life insurance plan. “I just hope something can be done about those machines,” she said.

The International Consortium of Investigative Journalists hosted a live virtual discussion exploring findings of its Cancer Calculus investigation.

The event featured ICIJ chief reporter Sydney P. Freedberg and Serif Health health economist and senior director of analytics Bill Pajerowski. ICIJ digital producer Carmen Molina Acosta led the discussion.

Drawing on reporting with 47 media partners around the world, the Cancer Calculus investigation examines how pharmaceutical industry practices tied to patents, pricing and billing can drive up costs and limit access to lifesaving cancer treatment. The conversation included behind-the-scenes insights into the reporting, key findings from the investigation and why they matter, discussion of broader pharmaceutical pricing practices and an audience Q&A.

For your invitation to future events, please subscribe to ICIJ’s newsletter or consider making a donation to support our work.

https://www.icij.org/investigations/cancer-calculus/following-the-paper-trail-to-guatemala-to-uncover-what-records-cant-reveal-about-access-to-keytruda/

BEHIND THE SCENES Following the paper trail to Guatemala to uncover what records can’t reveal about access to Keytruda May 11, 2026

https://www.icij.org/investigations/cancer-calculus/video-keytruda-merck-patients-patents/

VIDEO WATCH: How Merck keeps Keytruda prices sky-high Apr 13, 2026

https://www.icij.org/investigations/cancer-calculus/unacceptable-lawmakers-react-to-revelations-from-icijs-cancer-calculus-investigation/

IMPACT ‘Unacceptable’: Lawmakers react to revelations from ICIJ’s Cancer Calculus investigation Apr 23, 2026

Recommended reading BEHIND THE SCENES Following the paper trail to Guatemala to uncover what records can’t reveal about access to Keytruda May 11, 2026 VIDEO WATCH: How Merck keeps Keytruda prices sky-high Apr 13, 2026 IMPACT ‘Unacceptable’: Lawmakers react to revelations from ICIJ’s Cancer Calculus investigation Apr 23, 2026