Which Country Is Keytruda (Pembrolizumab) Cheapest In? — 2026 Guide

Why does the price differ so much between countries?

Keytruda (pembrolizumab) is a PD-1 immune checkpoint inhibitor administered by hospital infusion, which puts it squarely inside every country's institutional procurement machinery rather than a retail pharmacy shelf. In Türkiye, the Ministry of Health anchors the reference price to the lowest ex-factory price found in a designated basket of five to ten EU member states, then converts that price using the "pharmaceutical euro" (Dönemsel Avro Değeri) — fixed at 65% of the previous year's average Central Bank euro rate rather than the live spot rate. That mechanism, published via the TİTCK price list and gazetted in the Resmî Gazete, is the single biggest reason Turkish list prices for biologics like Keytruda sit well below list prices in markets that set prices freely.

Germany takes a different route under its AMNOG framework: a new oncology biologic can be launched at a manufacturer-set free price for the first six months, after which a negotiated price is applied — and that negotiated price is backdated to month seven, not the launch date. The United Kingdom's NICE evaluates cost-effectiveness against a cost-per-QALY threshold that was raised from the long-standing £20,000–£30,000 band to £25,000–£35,000, announced 1 December 2025 and taking effect from April 2026 (see NICE); a higher threshold changes what "cost-effective" means for a checkpoint inhibitor but is not itself a price.

The United States has no equivalent government reference mechanism for a drug like Keytruda: pricing is essentially free at launch and negotiated privately between manufacturers, payers and pharmacy benefit managers. The RAND Corporation's 2022 international price comparison, published 1 February 2024, found gross US list prices averaged 278% of prices in 33 other high-income countries across all drugs, and 422% for brand-name originator products specifically — a structural gap, not a Keytruda-specific figure.

Because Keytruda is hospital-administered, most institutions never pay the headline list price: they procure through tenders and confidential discounts. A Frontiers in Pharmacology study published 9 March 2026, covering 23 hospitals across 9 European countries, found actual hospital acquisition prices running 7%–38% below the published reference price for the same products. Every comparison you see online, including this one, should therefore be read as a comparison of "list prices," not of what any hospital or patient actually pays. For the underlying mechanics of why Türkiye's published prices sit where they do, see our explainer on why medicines cost less in Türkiye.

How is the price set in each country?

The table below compares pricing systems, not prices. Each country publishes — or does not publish — its own official list, and that published list is the only figure worth relying on. Follow the link in the last column and read the current entry yourself.

How can I obtain a medicine legally from a lower-price market?

There is a lawful route in most countries, and it starts in the same place everywhere: a valid prescription in your own name, issued by the physician treating you. What differs is the import permit. The procedures below are stated only where they could be verified at the national authority.

United Arab Emirates. MOHAP operates a permit to import medicines for personal use through its Electronic Drug Establishment service. The permit is free and is issued within 3 working days. You log in with a MOHAP account or UAE Pass.

Saudi Arabia. Applications run through the SFDA Controlled Drugs System at cds.sfda.gov.sa, under a guideline published on 14 August 2025. Read the current SFDA regulations page before you travel — the requirements are revised periodically.

Qatar. For non-controlled medicines there is no pre-approval: you may carry up to a 60-day supply through the Green Channel, in the original packaging, with a copy of the prescription and a signed, stamped letter from your doctor. For controlled medicines you need advance approval and must use the Red Channel; supporting documents must be no older than 6 months and in Arabic or English.

Kuwait and Azerbaijan. Confirm the current procedure directly with the national authority before shipping or travelling — Kuwait Ministry of Health and Azerbaijan Tariff Council. We do not publish a step list for these two countries because the procedure could not be verified at source.

1. United Arab Emirates — obtain a prescription in the applicant's own name, issued within the last 3 months.
2. Obtain a medical report from the treating facility, authenticated by the health authority and issued within the last year.
3. Prepare an Emirates ID or passport copy for the applicant.
4. Log in to the MOHAP service with a MOHAP account or UAE Pass and submit the personal-import application.
5. Keep the quantity within the limit: no more than a 1-month supply for controlled medicines, and no more than a 3-month supply for non-controlled medicines.
6. Wait for the decision — the service is free and normally issued within 3 working days.
7. Contact MOHAP on 800 111 11 or at import.export@mohap.gov.ae if the application stalls.

What is named patient supply?

Named patient supply is the international concept behind almost every lawful cross-border medicine route. The clearest codified example is the United Kingdom's MHRA Guidance Note 14, built on Regulation 167 of the Human Medicines Regulations 2012.

Four conditions define it: the order must be unsolicited; the product must be specified by the prescriber; the prescriber must be directly responsible for the patient; and there must be a genuine special clinical need that no authorised product meets.

The honesty point matters here: the European Court has held that "financial considerations cannot, in themselves" establish a special clinical need. A lower price in another country is not, by itself, a lawful basis for a named-patient import. The lawful bases are clinical.

Is the Keytruda I'm being offered genuine?

Keytruda is one of the more frequently reported falsified biologics globally. The WHO has logged 36 product reports concerning falsified Keytruda since 2019, and Mexico's regulator, Cofepris, issued public alerts in 2022 and again in September 2024. A 2024 raid in Guadalajara recovered roughly 12,500 doses of counterfeit medicines, including falsified Keytruda, from an unlicensed distribution operation.

A separate case spanning India and Nepal is a useful cautionary example: investigators recovered 519 empty vials bearing Keytruda branding, and when Merck tested 9 samples from the supply chain, 8 of them contained no pembrolizumab at all — meaning patients had received an infusion with no active drug. Anyone sourcing Keytruda outside a licensed hospital pharmacy should treat that case as the baseline risk, not the exception.

• Scan the carton's GS1 DataMatrix and confirm it decodes to AI 01 (GTIN), AI 21 (serial number), AI 17 (expiry) and AI 10 (batch) — a code that will not scan, or scans to the wrong product, is a hard stop.
• If the vial is sourced in Türkiye, check that its karekod is notified to the national İlaç Takip Sistemi (İTS) track-and-trace system at its.saglik.gov.tr before it leaves the pharmacy.
• Ask for a continuous 2–8°C temperature log covering the actual shipment you are receiving, not a generic cold-chain certificate — Keytruda must never be frozen or shaken.
• Cross-check the batch and lot number against the WHO's live list at our WHO falsified medicine alerts tracker before administration.
• Be suspicious of any website offering a public "manufacturer batch checker": Merck does not operate one, so a site claiming to verify Keytruda batches this way is itself a red flag.
• If anything about packaging, vial fill level or labelling looks inconsistent, call Merck's National Service Center at 1-800-444-2080 before the dose is administered.
• Review the full verification workflow in our guide to checking that a medicine is genuine.

Frequently asked questions

Sources

• Resmî Gazete — Beşeri Tıbbi Ürünlerin Fiyatlandırılmasına Dair Karar No. 11031 — retrieved: 2026-07-28
• TİTCK — published medicine price list — retrieved: 2026-07-28
• MOHAP (UAE) — import medicine for personal use — retrieved: 2026-07-28
• SFDA (Saudi Arabia) — regulations — retrieved: 2026-07-28
• SFDA Controlled Drugs System — retrieved: 2026-07-28
• Qatar MOPH — drug prices — retrieved: 2026-07-28
• Kuwait Ministry of Health — retrieved: 2026-07-28
• Azerbaijan Tariff Council (Tarif Şurası) — retrieved: 2026-07-28
• NICE (United Kingdom) — retrieved: 2026-07-28
• G-BA (Germany) — AMNOG benefit assessment — retrieved: 2026-07-28
• RAND — International prescription drug price comparisons (published 1 Feb 2024) — retrieved: 2026-07-28
• Frontiers in Pharmacology — European hospital price transparency study (9 Mar 2026) — retrieved: 2026-07-28
• MHRA Guidance Note 14 — supply of unlicensed medicinal products — retrieved: 2026-07-28

Country availability pages for this medicine

Related pages

Immune checkpoint inhibitors

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