Eligible Patients · India · 2020
0
Lung (98,278) + Cervical (75,209) · ICMR NCRP 2020
Estimated Patients Treated
~200
Model output · author-constructed funnel
Effective Access Rate
<0.3%
Primary finding · affordability bottleneck
Keytruda Global Revenue FY2023
$25.0B
41.6% of Merck total revenue · +19% YoY
01 · Access Funnel
Patient Journey to Treatment
7-stage model. Each bar = patients remaining after drop-off. India only.
<0.3%
Of 1,73,487 annually eligible patients, an estimated ~200 reach pembrolizumab.
Primary bottleneck: affordability, not diagnosis or infrastructure.
04 · Payer Mix
Who Pays — India vs United States
Government coverage vs patient out-of-pocket as % of annual treatment cost.
🇺🇸 United States
Medicare Part B — ~80% (~$154K/yr)
Patient OOP — ~20% (~$38K/yr)
Medicare cap: Most Advantage plans cap OOP at $3K–7K/yr.
🇮🇳 India
PMJAY — ₹5L limit (~15% of ₹34L cost)
Patient OOP — ₹29L (~85% of cost)
Structural gap: ₹29L OOP = 15× India's per capita annual income.
02 · Affordability
Cost as Multiple of Per Capita Income
One year of Keytruda equals how many years of average income?
The arithmetic of exclusion: In the US, Keytruda costs ~2.5× per capita income — expensive, but bridgeable with insurance.
In India, it costs ~17×. Even with PMJAY, the patient still owes 15× their annual income out-of-pocket.
05 · Scenario Analysis
Tiered Pricing Threshold for Access
Annual cost vs PMJAY ₹5L ceiling. Green line = reimbursement threshold.
Scenario C only — a 90%+ price reduction — brings annual cost within PMJAY's ₹5 lakh reimbursement limit.
Precedent: Merck's HIV tiered pricing in Sub-Saharan Africa.
03 · Coverage Gap
PMJAY Coverage vs Annual Treatment Cost
Visual decomposition of the ₹34L annual Keytruda cost against PMJAY's ₹5L ceiling. Amounts in Indian Rupees.
₹5,00,000
PMJAY Annual Limit
₹29,00,000
Patient OOP Gap
₹34,00,000
Total Annual Cost