REVEALED: From cancer to arthritis, how drug companies are selling treatments for 1,000 times what they cost to make - and the crippling cost to the NHS

REVEALED: From cancer to arthritis, how drug companies are selling treatments for 1,000 times what they cost to make - and the crippling cost to the NHS By ADAM LUCK Published: 00:40, 29 April 2025 | Updated: 00:40, 29 April 2025 e-mail View comments When Roy Bradley was told he had cancer in his lungs and liver, his first thought was he couldn’t face chemotherapy and should prepare for his death. A few years earlier in 2012, the 90-year-old retired rail engineer, from Crewe in Cheshire, had seen his wife Mary suffer throughout her chemotherapy treatment before succumbing to pancreatic cancer aged 77. ‘When they told me that I had cancer I thought “that’s it” as I didn’t want chemotherapy,’ says Roy.

‘Mary had endured two years of it, she lost her hair, couldn’t eat, and was exhausted all the time. I didn’t want that for myself.’ But then Roy’s consultant told him he could have a revolutionary new drug, pembrolizumab.



‘And all they needed to do was insert a cannula in my wrist, which would deliver an hour-long infusion every three weeks,’ he recalls . Pembrolizumab is one of the first immunotherapy drugs for cancer. It harnesses the body’s own immune system and teaches it to attack tumours.

Better known by its brand name Keytruda, it was first approved in 2015 by the NHS for melanoma, a dangerous form of skin cancer, but is now used to treat an ever-increasing roster of cancers, including of the breast and cervix. It’s fair to say drugs such as Keytruda have transformed the landscape of cancer treatment. Roy Bradley, 90, thought he needed to prepare for his death until he was offered a revolutionary new drug, pembrolizumab The drug is priceless for the retired rail engineer, who has cancer of the lung and liver But there is a price to pay – and it’s a ‘grotesque’ one, according to Dr Andrew Hill, a visiting research fellow in the department of pharmacology and therapeutics at the University of Liverpool.

‘These cancer drugs are sold routinely for between 100 and 1,000 times what they cost to make,’ says Dr Hill. He and others have accused leading drug companies of over-charging the NHS millions of pounds a year using the argument they need to recoup their huge investment in research and development for the breakthrough medicines. However, in many cases, much of the initial legwork was done by small biotechs or academic institutions.

When a pharmaceutical company develops a new treatment it applies for a patent, which can stop rival firms from copying the medication and undercutting them on price for up to 20 years. And it seems the big pharma companies, which haggle with the NHS over pricing of their patented medicines, have been extracting an ever-larger slice of the NHS budget. The price for Roy’s treatment is around £52,000 a year, according to research based on NHS figures.

The amount the NHS spends on branded medications (as opposed to cheaper copies, called generic drugs) has been increasing by more than 5 per cent each year, according to a report last year by York University, the London School of Economics and London School of Hygiene & Tropical Medicine. Scientists warned branded medicines threaten the financial stability of the NHS. There are no cheaper generic alternatives to pembrolizumab, so the NHS has to foot the bill.

When a pharmaceutical company develops a new treatment it applies for a patent, which can stop rival firms from copying the medication and undercutting them on price for up to 20 years Jeff Cook, 76, pictured with wife Carol, 73, is now able to spend his time gardening and feeding the birds after receiving similar treatment But for patients such as Roy, the drug is priceless. The first sign all was not well came in 2014 when Roy’s GP noticed an abnormal growth on his scalp during a routine check. It was malignant melanoma and Roy was referred to a cancer hospital in Manchester where doctors removed a 3in by 4in patch of skin from his head.

He underwent regular scans for monitoring before one in 2018 revealed cancerous cells in his liver and lungs. The prognosis was grim: nine to 12 months with the standard of care at that time, which was chemotherapy. But then Roy, a father of one, started a two-year course of pembrolizumab.

‘It could not be easier,’ he says. ‘I just walked into a ward, sat for an hour while they gave me the drug, then went home – or out.’ Five years after treatment finished, Roy is still clear of cancer.

He says: ‘I am into biking, I work for a charity and am involved with the Scouts and the local church. The retired sales rep from Northwich, Cheshire, was suffering from stage 4 lung cancer, as shown by this scan from before he started a two-year pembrolizumab course Mr Cook was able to live a normal life after just a handful of treatments, with this post-medication scan displaying the drug's impressive impact ‘There is plenty going on – I make the most of my life. I could not hope for better.

All thanks to pembrolizumab.’ ‘The drug has cured him,’ says Dr Patricio Serra, Roy’s oncologist. ‘Some people hesitate to use that term, but I think that immunotherapy has changed that.

‘Roy’s coming to the point next year where we can stop doing scans and discharge him.’ Dr Serra says while 5 to 10 per cent of patients survive five years with chemotherapy, this rises to 40 to 45 per cent when using pembrolizumab. ‘That is a big step,’ he says.

‘Immunotherapy in general and Keytruda in particular. I see it as a revolution.’ Jeff Cook, 76, a retired sales rep from Northwich, Cheshire, also had a remarkable recovery thanks to pembrolizumab after being diagnosed with stage 4 lung cancer in 2019.

This came after he developed a weeping sore on his chest that antibiotics failed to clear. After radiotherapy to target the tumour directly, he was put on a two-year course of pembrolizumab. He said, ‘after just three or four treatments, I was leading a normal life again’.

The father-of-two, who is married to Carol, 73, is now able to spend his time gardening and feeding the birds. ‘Considering I had such an advanced cancer, the pembrolizumab has been a medical miracle,’ he says. No wonder the medication is now being used in the NHS to treat, among others, breast, bowel, skin and cervical cancers.

The UK is far from alone in its growing reliance on pembrolizumab, with Keytruda generating a staggering £19billion in revenue globally for pharmaceutical giant MSD in 2023 alone. This makes pembrolizumab the world’s most successful drug in terms of global profit. And this matters because medicines are the second-largest item on the NHS bill, after salaries, accounting for £19.

2billion of its budget in England alone in 2022/23, with branded medicines – everything from Keytruda to Gaviscon and EpiPen – accounting for £14billion. Indeed, pembrolizumab was among the top ten most expensive drugs for the NHS, according to a 2023 report produced by the campaign group Global Justice Now. The report used export data to obtain the prices of key pharmaceutical ingredients as well as peer-reviewed academic research formulae and papers, to calculate the figures.

It focused on the drugs that cost the NHS the most between 2012 to 2022. Remarkably many of the drugs, including pembrolizumab, were not available throughout much of that period – yet still drained millions from NHS coffers. Global Justice Now estimates that pembrolizumab costs the NHS around £775 per 50mg, but its actual cost to manufacture, according to its calculations, is estimated to be no more than £18 per 50mg.

The typical dosage for a single treatment varies depending on the cancer, but can be 200mg every three weeks. This means if the NHS had obtained the medicine at cost price it would have saved at least £1.06billion, according to the report (the authors did not factor in the cost of research and development, but Global Justice Now claims this is often grossly inflated, more on that later).

Whatever the cost of developing drugs, pharmaceutical companies generate gargantuan profits that you might assume provide the Chancellor of the Exchequer with substantial tax revenues. In fact, many stand accused by the US Senate Finance Committee of using tax loopholes globally to funnel revenue to subsidiaries in low-tax countries. MSD is no exception according to a report last year by Investigate Europe, a consortium of investigative journalists.

This identified the company as having 140 subsidiaries in tax-friendly jurisdictions, including Switzerland and Ireland. Topping the chart for off-shore subsidiaries is US giant AbbVie. The company makes Humira, which is medically known as adalimumab, which tops the list of the ten most expensive drugs for the NHS in England.

Humira is used to treat inflammatory conditions including rheumatoid arthritis and costs the NHS around £9,000 per patient a year. In a landmark case AbbVie is now being sued in the Netherlands for excessive pricing of Humira. The Dutch-based Pharmaceutical Accountability Foundation claims the company used its dominant market position to overcharge the Dutch healthcare system by up to £1billion over 14 years, calculating it made a profit margin of up to 78 per cent globally.

AbbVie has declined to comment to Good Health. ‘We need to be looking to pharmaceutical companies to pay their fair share,’ argues Dr Hill. Yet, exactly what that is might be difficult to ascertain, as the true amount the NHS pays for these drugs is shrouded in secrecy and commercial confidentiality.

For example, the ‘list price’ – the manufacturer’s suggested retail price, which is public – for pembrolizumab is £84,000 per patient per year. In reality the UK Government negotiates a confidential discount behind closed doors. Read More REVEALED: The sinister tricks Big Food is using to hide ultra-processed ingredients The Bitter Pills report, published in 2023 by Global Justice Now and looking into ‘why the NHS can’t swallow Big Pharma’s profiteering’, estimates the average discount is around 41 per cent, which means Keytruda costs £49,500 per patient.

It might look like a good deal for the NHS but the same drug in the Netherlands costs £33,000 to £41,000 per patient, according to a report last year by Erasmus University in Rotterdam. And the Bitter Pills report estimates the cost of producing Keytruda stands between 0.8 to 2.

4 per cent of the current price, not allowing for research and development costs. Big Pharma argues this is a huge financial burden. But is it really? Take pembrolizumab, a drug that uses an adapted antibody (a protective protein that attacks foreign substances) to stop malignant cells being able to ‘hide’ from our immune system, which can then destroy them.

Yet the origins of the drug lie not in a US commercial laboratory, but rather in publicly funded laboratories in the UK. Scientists at the Medical Research Council’s Laboratory of Molecular Biology, which is UK Government-funded, pioneered the isolation of the individual antibodies from mice – and then the research which adapted these for use in humans. This enabled development of therapies such as Humira (for rheumatoid arthritis), Lemtrada (for multiple sclerosis) and Herceptin (for breast cancer).

The specific work on pembrolizumab was undertaken by LifeArc, formerly MRC Technology, which was set up by the publicly funded UK Medical Research Council to help develop ground-breaking drugs. LifeArc is a charity: its work involved changing portions of the mouse antibody so it more closely resembles that of a human antibody. This meant that it could be used in clinical trial on humans.

LifeArc subsequently sold on its stake in pembrolizumab. When approached by Good Health, LifeArc refused to go into its earnings from this deal, citing confidentiality clauses, although experts suggest this is likely to be a fraction of the pembrolizumab profits realised by MSD. ‘We discovered that not only are big pharmaceutical companies charging astronomical mark-ups on key NHS medicines, but that these same companies have often played only a relatively small role in developing them,’ says Tim Bierley, who helped author Global Justice Now’s Bitter Pills report.

‘Many of these medicines have been developed primarily with funding and support from the public sector. ‘So, essentially, this means that we are being charged twice for medicines,’ he told Good Health. ‘Rightly investing in their development, but then also handing over astronomical amounts of money to Big Pharma for little more than their brand name being on the label.

’ Dr Hill says drug firms could slash prices and still make a decent profit. ‘It is just a question of saying to drug companies, you need to start thinking about lower prices, otherwise, fundamentally, it is unaffordable,’ he told Good Health. Much of the money, he believes, would be better spent on prevention, extra NHS staff, facilities and equipment rather than branded medicines.

‘Drug companies say that when you’re paying for a drug, you’re not just paying for that drug’s development but all the drugs that failed – and if they didn’t charge for those, they wouldn’t be able to afford any development at all,’ says Dr Hill. ‘But often these drug companies are actually buying the drug from a biotech company that’s already taken a large part of the risk. ‘The great example here is the Oxford University malaria vaccine.

They were public about how much it cost them to develop and it was not billions.’ This vaccine is now being made by Serum Institute of India, the world’s largest manufacturer of vaccines. ‘There are other examples of independent organisations running trials and running them very cheaply,’ says Dr Hill.

In 2023 a report by economists William Lazonick and Oner Tulum, which analysed the 14 largest listed pharmaceutical companies in the US, stated they’d spent $747billion (£560 billion) on share buybacks and dividends compared to $660billion on research and development. In a joint statement, MRC and LifeArc told Good Health that while the MRC had funded the establishment of what became LifeArc, it did not provide specific funding for the development of pembrolizumab. ‘LifeArc, as a not-for-profit charity, reinvests this money [eg royalties] into the development of new medicines and diagnostic tools,’ they said.

An MSD spokesman said: ‘All new medicines and significant extensions of their licence undergo a comprehensive NICE evaluation of their costs and benefits before being made available to NHS patients. ‘On top of this assessment, medicines are subject to further price reductions and cost-control measures, as well as additional industry-wide rebates on branded medicine sales.’ Last October, Manifest, a new multi-million-pound research programme in immunotherapy, which is backed by public money, was unveiled in the UK.

The project will be led by the Francis Crick Institute in London and brings together universities, NHS trusts and bioscience companies to advance research. Project lead Samra Turajlic said they hope it will ‘fuel more discoveries regarding cancer immunology and new therapies’. Who will walk away with the patents and profits remains to be seen.

A spokesman for NHS England told Good Health: ‘NHS England has a strong track record of using its commercial capabilities to unlock access to medicines in a way that delivers for both patients and taxpayers – while also maintaining collaborative partnerships with the life sciences industry.’ However, as Beth Woods, senior research fellow in the Centre for Health Economics at the University of York, puts it: ‘Incentivising the development of new medicines is important, but the right balance needs to be struck – especially when budgets are tight. ‘And the pharmaceutical industry is currently getting too big a slice of the pie.

’ NHS Share or comment on this article: REVEALED: From cancer to arthritis, how drug companies are selling treatments for 1,000 times what they cost to make - and the crippling cost to the NHS e-mail Add comment Comments 0 Share what you think No comments have so far been submitted. Why not be the first to send us your thoughts, or debate this issue live on our message boards. Add your comment Enter your comment By posting your comment you agree to our house rules .

Submit Comment Clear Close Do you want to automatically post your MailOnline comments to your Facebook Timeline? Your comment will be posted to MailOnline as usual. No Yes Close Do you want to automatically post your MailOnline comments to your Facebook Timeline? Your comment will be posted to MailOnline as usual We will automatically post your comment and a link to the news story to your Facebook timeline at the same time it is posted on MailOnline. To do this we will link your MailOnline account with your Facebook account.

We’ll ask you to confirm this for your first post to Facebook. You can choose on each post whether you would like it to be posted to Facebook. Your details from Facebook will be used to provide you with tailored content, marketing and ads in line with our Privacy Policy .

.