A significant intersection of one of the fastest-growing cancer demographics and a high-cost cancer treatment unfolds in a modest dwelling in Punjab, India. In early 2022, a 56-year-old woman residing near Chandigarh commenced her battle with liver cancer at PGIMER. Here, her doctors proposed the use of Keytruda, an immunotherapy drug produced by the American pharmaceutical giant Merck & Co. (MSD). Unfortunately, the steep price tag of over Rs 1.5 lakh for a 100 mg vial rendered it unaffordable for most families.
Burdened by the financial strain, the woman’s family procured twelve vials from a local pharmacy between September and December 2022 at a “discounted” rate, totaling approximately Rs 16 lakh. However, their relief quickly turned to distress when they received a call from the Delhi police informing them that the drugs they had used were counterfeit, containing antifungal agents instead of the intended medication.
This incident is just one example within a burgeoning market for counterfeit Keytruda in India, as revealed by a joint investigation conducted by The Indian Express and the International Consortium of Investigative Journalists (ICIJ). The inquiry involved analyzing over 12,500 pages of police and hospital records, alongside interviews with various hospital personnel, including oncologists. It also examined records from more than 150 patients in the national capital who had received authentic Keytruda, confirming that the batch numbers matched those seized from employees at leading hospitals in Delhi.
On a global scale, the ICIJ investigation highlights how one of the largest pharmaceutical companies employed strategies to boost prescription volumes and maintain high prices through lobbying efforts, while simultaneously attempting to block more affordable versions of the drug from reaching countless cancer patients. The investigation also uncovered counterfeit operations spanning from Nepal to Mexico.
Counterfeit medications are prevalent across various drugs in India, from antibiotics to antacids. However, as The Indian Express spoke with individuals who had received fake Keytruda, a broader narrative emerged, shedding light on the murky interplay between global pharmaceutical practices, government regulations, and hospital oversight. This scenario has fostered a corrupt network that operates with little fear of consequences, distributing adulterated life-saving medications.
For the woman from Chandigarh, whose family comes from a background of small-scale farmers, the vials arrived in temperature-controlled packaging, with labels that appeared legitimate, and were administered in the hospital without raising any suspicions. Her granddaughter remarked, “We believed we were purchasing genuine products. The financial burden of cancer treatment is overwhelming. We are still repaying loans we took out. We’ve now had to cease Keytruda; we simply cannot afford it.”
Like many others interviewed for this article, this family had no insurance coverage, reimbursement options, or safety nets. They were unaware that their Keytruda vials had been supplied to the pharmacy by a distributor under police surveillance.
When the police reached out to the family, investigators had already begun assembling evidence suggesting a multi-city operation involved in the distribution of counterfeit high-value cancer drugs, including Keytruda. The distributor, identified as Neeraj Chauhan (38), was arrested along with eleven others and is considered a key player in a larger network. He currently remains in judicial custody, and following a First Information Report (FIR) filed by Delhi Police, the Enforcement Directorate has launched a money laundering investigation.
Investigators indicate that the operation employed a sophisticated scheme: empty Keytruda vials were collected, refilled with other injectable substances—often antifungal drugs—and resealed for sale at prices as low as Rs 90,000 for a 100 mg vial, representing a 40% discount from retail price. “Even a small discount can make a difference,” the granddaughter explained. “When something is even slightly cheaper, it feels like a relief amidst all the uncertainty. You don’t question; you just trust the system.”
On March 11, 2024, police apprehended Chauhan in Gurugram and conducted a search of his residence. They reportedly discovered multiple vials labeled as Keytruda, linked to batches X018554, X026725, X020722, and W033216: 46 filled vials, 165 unfilled vials, and 239 empty packing boxes. These batch numbers became crucial to the investigation, according to law enforcement officials.
The inquiry led to one of India’s esteemed oncology departments. On March 12, 2024, two men exited the cytotoxic mixing unit located on the second floor of D Block at the Rajiv Gandhi Cancer Institute and Research Centre (RGCIRC) in Delhi—a pharmacy facility closely monitored by CCTV, where potent anti-cancer medications are prepared and dispensed. One of the men carried a black and blue bag, while the other had a backpack. Neither made it to the exit before being intercepted by Crime Branch officers.
Inside Komal Tiwari’s bag were five semi-filled vials of Keytruda (100 mg/4ml)—four marked with batch number W031928 and one with batch number X018554—along with three empty Keytruda boxes from the same batch. Abhinay’s backpack contained another five semi-filled vials from batch numbers W008961, W029734, W023257, and two from batch number X018554, as well as two empty boxes from batches W031928 and W034646.
Together, the two pharmacists were carrying ten semi-filled vials of one of the world’s most expensive cancer treatments and five empty boxes, concealed in common luggage, through the corridors of the hospital. The items were placed in a plastic container, sealed with tape, and marked “SS.” These vials have become key pieces of evidence in the case against a twelve-member syndicate. Tiwari and Abhinay have since been released on bail.
