24.06.2026 à 15:30
Law enforcement, banks warn of money laundering gaps in major US crypto bill
Brenda Medina
Texte intégral (763 mots)
Law enforcement associations, anti-corruption advocates and a major banking group are warning that a new bill aimed at regulating the United States’ cryptocurrency industry could leave big gaps in safeguards against dirty money in digital currencies that have already become a financial vehicle for organized crime.
Known as the Clarity Act, the bill seeks to bring cryptocurrency under a single legal framework on the national level, ending years of the industry operating in gray areas. Crypto companies and President Donald Trump have heavily championed the bill. Defenders of the bill say that it fills a crucial regulatory vacuum and provides law enforcement with new tools to address crime. But critics argue it contains dangerous loopholes and prioritizes studies and pilot programs instead of holding all crypto services to stringent anti-money laundering standards.
This is largely window-dressing type regulation.
— Gary Kalman, executive director of Transparency International U.S.
In recent months, law enforcement groups including the National Sheriffs’ Association and the National Association of Assistant U.S. Attorneys have sent letters to lawmakers voicing a common concern: They argue that the bill could create regulatory exemptions for certain decentralized and automated cryptocurrency services that criminals often rely on to obfuscate their fund flows.
Yesterday, four law enforcement groups representing police chiefs, sheriffs and prosecutors told the acting U.S. Attorney General that, despite discussions with senior officials across the Trump administration, their concern that the bill’s “broad exemptions could create gaps in oversight and accountability that sophisticated criminal actors may exploit” remains unresolved. The letter said its signatories represent more than 70,000 law enforcement professionals across the U.S.
“Criminal organizations increasingly utilize digital assets to facilitate and conceal unlawful activity, including narcotics trafficking, fraud, child exploitation, ransomware attacks, sanctions evasion, terrorism financing, organized retail crime, and other forms of transnational criminal activity,” the letter states, pointing to exemptions for some decentralized businesses. “Regulatory certainty should not come at the expense of accountability, transparency, victim protection, or public safety.”
Key industry players disagree with these groups’ criticisms of the bill. The bill’s alleged loophole for decentralized services “does not exist,” Robin Cook, the director of U.S. Policy at the crypto giant Coinbase, told ICIJ in an interview. Cook points to a section 301 of the bill that he says will in fact bring most automated trading protocols under traditional anti-money laundering requirements.
“It is bringing new regulation at the federal level where there isn’t any today,” Cook told ICIJ. “That is not a deregulatory bill. The idea that somehow this is deregulatory is demonstrably false.”
The Coin Laundry, an investigation by the International Consortium of Investigative Journalists and 37 partner publications, found that criminals and other suspect actors commonly relied on decentralized trading protocols that can help make financial trails harder for law enforcement to trace.
cryptocurrency Trump administration curbs state oversight of crypto industry May 15, 2026
Recommended reading cryptocurrency Trump administration curbs state oversight of crypto industry May 15, 2026 CRYPTO Landmark cryptocurrency legislation passes US House, to be signed into law by President Trump Jul 18, 2025 CRYPTOCURRENCY Crypto giants moved billions linked to money launderers, drug traffickers and North Korean hackers Nov 17, 2025
23.06.2026 à 22:31
Cyprus anti-corruption watchdog refers former president to prosecutors for alleged ‘abuse of power’
Dean Starkman
Texte intégral (573 mots)
Cyprus’ anti-corruption authority has found “potential acts of corruption” and “abuse of power” by former President Nicos Anastasiades during his 10 years in office, referring possible criminal charges to prosecutors for further scrutiny.
The country’s Independent Anti-Corruption Authority alleges Anastasiades may have improperly tried to influence investigations into suspected payments to political parties and politicians, intervened in a Russian oligarch’s citizenship application, and may have used his office to stymie an anti-money laundering probe involving his former law firm.
Last week, the authority announced the criminal referrals to the attorney general in a sprawling 16,000-word statement summarizing its investigation into allegations made in “Kratos Mafia,” or “Mafia State,” a 2022 book by Makarios Drousiotis, a former Anastasiades aide turned investigative journalist.
The announcement includes a chapter-by-chapter breakdown of Drousiotis’ book, following the watchdog’s two-year investigation into those allegations that fell under its purview. The authority said it issued summons and interviewed key witnesses, including Drousiotis and Anastasiades himself, who “testified for many hours, spanning more than one day.”
The referrals to the attorney general were made as part of a confidential “final report” comprising more than 3,000 pages, along with other supporting documents. The authority cautioned that every person mentioned in the report carried a presumption of innocence and that “only a court of law is competent to determine a person’s guilt.” Anastasiades has repeatedly denied wrongdoing.
The Independent Anti-Corruption Authority was created in 2022 under pressure from the European Union and the U.S. to address longstanding concerns about public corruption in Cyprus and its rise to become a crucial financial hub for Vladimir Putin’s regime in Russia.
https://www.icij.org/investigations/cyprus-confidential/cyprus-russia-eu-secrecy-tax-haven/
https://www.icij.org/investigations/pandora-papers/global-investigation-tax-havens-offshore/
Recommended reading EUROPE How Cyprus rose to become the beating heart of the Putin regime’s shadow financial system Nov 14, 2023 OVERVIEW Cyprus ignores Russian atrocities, Western sanctions to shield vast wealth of Putin allies Nov 14, 2023 GLOBAL OVERVIEW Offshore havens and hidden riches of world leaders and billionaires exposed in unprecedented leak Oct 03, 2021
11.06.2026 à 21:16
Lowering doses of cancer drugs could slash global health spending by $30B, new research shows
Brenda Medina
Texte intégral (721 mots)
New studies presented at the American Society of Clinical Oncology’s annual conference suggest that reducing the dosage of anti-cancer medicines — including Keytruda, the world’s bestselling drug — could drastically cut global health costs by billions of dollars a year and improve access for patients.
The U.S. Food and Drug Administration approved the initial dosage of Keytruda in 2014 based on a patient’s body weight, at 2 milligrams per kilogram. But Merck & Co., the maker of the drug, later changed to a fixed dosage with the FDA’s approval. Now Merck recommends 200 mg every three weeks or 400 mg every six weeks, regardless of the patient’s weight.
The studies discussed last week at the ASCO conference in Chicago, however, indicate that patients are receiving more of Keytruda and similar cancer drugs than necessary, which dramatically pushes up consumer costs and corporate profits — and that smaller doses work just as well. One study estimated the savings at more than $30 billion annually.
We found that by lowering the dose, we can expand access by 50 to 60%.
— Kumar Prabhash, oncologist at Tata Memorial Hospital in Mumbai.
Merck disagrees with that finding, saying in a statement to ICIJ that the FDA-approved doses “are based upon wide-ranging preclinical data and extensive clinical evidence.”
Meanwhile, an official from the U.S. Department of Health and Human Services told ICIJ that the agency supports scaling back cancer treatments if evidence shows it is safe to do so. Emily G. Hilliard, the agency’s senior press secretary, said the FDA “will continue to work with oncologic drug developers to determine the appropriate dosages that are safe and effective for patients.”
“[The National Cancer Institute] supports efforts to de-escalate cancer therapies when the evidence shows that fewer drugs or lower doses can be administered safely and effectively,” Hilliard said in a statement. “Receiving less treatment while maintaining efficacy can improve a patient’s quality of life, lower costs, require fewer clinic visits, and, most importantly, reduce treatment-related toxicity. Our goal is to ensure patients receive the most effective treatment with the fewest possible side effects.”
The Cancer Calculus, an investigation by ICIJ and 47 media partners published in April, shows how Merck has kept the price of the lifesaving drug sky-high by building a fortress of patents to deter competition and through opaque pricing. In the U.S., for example, a 200 mg dose of Keytruda costs $12,000, according to an ICIJ analysis.
https://www.icij.org/investigations/cancer-calculus/merck-keytruda-cancer-drug-price/
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
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 Mexico seizes suspicious Keytruda in raid to dismantle counterfeit medication ring Jun 04, 2026
nce, she said, “will give us the strength to persist and request our [Ministry of Health] and the national health council to proceed for less dose and to sponsor it and support it.”Editor’s note: Arnold Ventures has been a funder of ICIJ. Funders have no involvement in ICIJ’s editorial decisions.
08.06.2026 à 20:10
Trump intelligence adviser previously helped father pursue millions from Kremlin-linked bank, leaked documents show
David Kenner
Texte intégral (720 mots)
Amaryllis Fox Kennedy, a Trump administration adviser on intelligence issues who recently stepped down from two senior national security positions, previously helped her father secure at least $12 million from a Russian investment bank that cooperated with the Kremlin, leaked documents show.
Kennedy, a former CIA officer, was involved in the deal in 2009 and 2010 as head of an offshore corporation owned by her father. She was employed as a spy during those years, according to media reporting.
The documents show that as president of the British Virgin Islands-registered Helios Enterprises Limited, Kennedy was involved in an effort on behalf of her father, Hodson Thornber, to pressure a Moscow-based investment bank to fulfill a 2008 agreement to pay roughly $30 million for Helios’ shares in a large Ukrainian agricultural company. The Russian bank, Renaissance Capital, included former senior Russian intelligence officers in its top ranks.
Kennedy told ICIJ that she was appointed Helios’ president as she was preparing to leave government service, and in that position worked with her father to identify investments in consumer technology startups. She said that any involvement she had in the dispute with Renaissance Capital was “pro forma,” and that she “had no knowledge of or involvement in” the dispute or the business project in general.
“I lived in the United States the entire time I worked for Helios and never worked on any deals related to the farm business or Ukraine,” she wrote. “I’ve never met any of the people involved, nor ever visited Ukraine.”
She is also the daughter-in-law of Health and Human Services Secretary Robert F. Kennedy Jr. and managed his 2024 presidential campaign. In one podcast appearance, he called her “the smartest person I’ve ever met.”
Politics Intelligence official Amaryllis Fox Kennedy, a Gabbard ally, leaves two jobs May 19, 2026
https://www.icij.org/news/2026/06/fidelity-opened-account-for-epstein-even-as-outrage-grew/
Epstein files Fidelity opened account for Epstein, even as outrage grew Jun 01, 2026
cryptocurrency Trump administration curbs state oversight of crypto industry May 15, 2026
Recommended reading Politics Intelligence official Amaryllis Fox Kennedy, a Gabbard ally, leaves two jobs May 19, 2026 Epstein files Fidelity opened account for Epstein, even as outrage grew Jun 01, 2026 cryptocurrency Trump administration curbs state oversight of crypto industry May 15, 2026
AFL — a stake he held through Helios.In November 2008, Renaissance Capital agreed to purchase Helios’ shares in UAFL for roughly $30 million in three installments in 2008 and 2009. The deal came during the global financial crisis, which impaired banks worldwide and plunged Renaissance into crisis.
As the crisis unfolded, Thornber began to pressure the investment bank to make good on its commitment to buy his shares. In January 2009, Kennedy, as president of Helios, wrote to Renaissance Capital to formally request Thornber’s appointment to UAFL’s board of directors, which was Helios’s prerogative under the shareholders agreement.
Thornber said in an interview that he did not remember being appointed to UAFL’s board. Helios was dissolved in May 2025, according to British Virgin Islands corporate records.
According to the documents, Thornber used his position as UAFL director to demand access to correspondence and financial transactions related to his dispute with Renaissance. When the bank took too long to provide access to certain records, he sent his lawyers unannounced to the BVI offices of the firm’s corporate services provider to inspect them.
e, Kennedy replied: “Please, David, get a life.”05.06.2026 à 18:52
Chinese spies are posing as recruiters to target officials and journalists
Scilla Alecci
Lire plus (482 mots)
The U.S. and its key intelligence partners say that China’s military intelligence services are using online job platforms and networking sites to lure foreigners who have access to sensitive information.
In a bulletin released this week, the so-called Five Eyes alliance warned that Chinese intelligence officers were posing as recruiters on LinkedIn and other sites to target government and military personnel as well as journalists and academics who could have access to classified or privileged information. The Five Eyes include domestic security agencies from the U.S., the U.K., Canada, Australia and New Zealand
The officers build relationships with job candidates and may offer targets money in exchange for reports on topics of interest to the Chinese government, including defense and trade, according to the bulletin. Their goal is to “ultimately seek to acquire privileged military, political and economic intelligence that can provide China with a strategic and tactical advantage over the Five Eyes,” the bulletin said.
The warning echoes the experience of reporters with the International Consortium of Investigative Journalists, who were recently approached by these purported recruiters. After ICIJ published China Targets, an investigation into China’s transnational repression, the targets began receiving suspicious emails and messages on LinkedIn.
Recommended reading TRANSNATIONAL REPRESSION Phony whistleblowers, fake journalists and cyber spies: ICIJ network targeted after China Targets probe Apr 27, 2026 Digital repression Cyberattack against Uyghur rights activists shows hallmarks of Chinese repression tactics, researchers say Apr 28, 2025 OVERVIEW Inside China’s machinery of repression — and how it crushes dissent around the world Apr 28, 2025
04.06.2026 à 16:25
Mexico seizes suspicious Keytruda in raid to dismantle counterfeit medication ring
Isabella Cota
Texte intégral (802 mots)
Federal authorities in Mexico seized vials labeled as Keytruda, the world’s bestselling drug, during an operation to dismantle a counterfeit ring in a suburb outside of the capital city, sources with direct knowledge of the raid told the International Consortium of Investigative Journalists Friday. This is the second operation that has led to arrests where vials labeled as the cancer medication were seized.
In a joint operation in March, Mexico’s security ministry, Secretariat of the Navy (known as SEMAR) and the Attorney General’s office seized 15,000 doses of clonazepam, more than 100 counterfeit vaccines and 1,000 vaccine labels, believed to be used to produce falsified medication, according to an April press release. They also found guns, cocaine and five vials labeled Keytruda, two sources told ICIJ. Merck could not confirm whether the vials were real or counterfeit.
Keytruda, known generically as pembrolizumab, has been a game changer in cancer treatment — with a price to match. ICIJ’s Cancer Calculus investigation, published in April, revealed how the high cost of the drug has fueled demand for counterfeits.
Vials that appear to be labeled as Keytruda found in a raid by Mexican authorities in the town of Huixquilucan. Image: Mexico Security Ministry
The investigation, which brought together reporters in 37 countries, exposed the inner workings of a system that protects pharmaceutical pricing monopolies and prioritizes profit over access. Keytruda is produced by the pharmaceutical company Merck and Co., known as MSD outside of the United States and Canada.
In Mexico, reporters from Quinto Elemento Lab, El País, El Sol de México and Univision found that falsified vials of the cancer drug were supplied to public hospitals through medication distributors that, at times, do not comply with national health standards. One patient died while being infused with fake Keytruda, Merck confirmed as part of ICIJ’s previous reporting. Another patient, whose case was documented by Univision, claimed to suffer painful side effects after being administered falsified Keytruda twice in a public hospital in Mérida, the largest city in the state of Yucatán.
Only Merck can confirm if vials are authentic or counterfeit, since the patented formula is known only to the company. The five vials seized in the March raid remain in the custody of authorities and have not yet been provided to MSD for analysis, Anthony Zook, associate vice president for MSD Global Security, said in a statement to ICIJ.
“Therefore, we are not in a position to confirm their authenticity or whether they are genuine or falsified,” Zook said. “We continue to closely monitor the situation and stand ready to support the authorities should our technical expertise be requested.”
Two people, a man and a woman, were arrested during the March raid in the town of Huixquilucan, 59 miles west of Mexico City, according to the press release.
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
https://www.icij.org/investigations/cancer-calculus/merck-keytruda-cancer-drug-price/
Recommended reading COUNTERFEITS Counterfeiters cash in on the world’s bestselling cancer drug Apr 13, 2026 OVERVIEW How Merck turned its wonder drug into a blockbuster — and priced out cancer patients worldwide Apr 13, 2026 PARTNER STORIES A ‘burgeoning black market’, inflated dosing and the over-judicialization of health care: reporters around the world tell stories about Keytruda Apr 21, 2026
01.06.2026 à 19:05
Fidelity opened account for Epstein, even as outrage grew
Spencer Woodman
Texte intégral (592 mots)
Investment giant Fidelity opened a brokerage account for Jeffrey Epstein months before his 2019 arrest, according to a document reviewed by the International Consortium of Investigative Journalists. The account took in millions of dollars as Epstein publicly faced intense renewed scrutiny, according to the record.
The new details about Epstein’s finances, contained in data briefly published by the United States Justice Department and later removed, add Fidelity Investments, a firm with trillions of dollars in assets under management, to a list of financial institutions that moved large sums of money for Epstein.
Fidelity opened the account in mid-April 2019, and it received more than $5 million by the time Fidelity apparently moved to close it in late May of that year, several weeks before Epstein’s arrest on sex trafficking charges, according to the document.
Debra LaPrevotte, a former FBI agent specializing in corruption and financial crime, said that the significant public developments relating to the Epstein case “should have been enough that Fidelity did not want Epstein as a client.”
In late 2018, a Miami Herald series that identified more than 60 alleged victims of the disgraced financier ignited new interest and outrage around the Epstein case. The following February, a federal judge ruled that the Justice Department’s involvement in a lenient plea deal with Epstein in 2008 had violated the law, and the department opened an inquiry into its handling of the case. In March of 2019, a group of more than a hundred lawmakers demanded the Justice Department reopen the investigation into Epstein.
Fidelity did not respond to requests for comment. The revelations come from a Fidelity record that the Justice Department briefly published in late January as a part of its congressionally mandated disclosure of Epstein case files. The Justice Department subsequently withdrew the file and replaced it with a fully blacked-out version, although ICIJ retained a copy of the originally released file. The Justice Department did not respond to questions on why it withdrew the document.
FINCEN FILES Deutsche Bank agrees to pay $130 million in latest major US penalty Jan 12, 2021
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Recommended reading ACCOUNTABILITY As US-style corporate leniency deals for bribery and corruption go global, repeat offenders are on the rise Dec 13, 2022 FINCEN FILES Deutsche Bank agrees to pay $130 million in latest major US penalty Jan 12, 2021 Collaborative Journalism Pandora Papers reporting from across North America Nov 23, 2021
29.05.2026 à 15:06
Patents, prices and court files: How ICIJ used data to investigate an industry that thrives on secrecy
Denise Ajiri
Texte intégral (2048 mots)
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/
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.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.
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