Big fines and settlements barely dent cancer drugmakers’ revenues, fail to deter wrongdoing
An ICIJ review found nearly $1.7 billion in settlements and fines over a 15 year period. But experts said many companies see the payouts as the cost of doing business.
By Sydney P. Freedberg, Brenda Medina, Agustin Armendariz and Jesús Escudero
September 2, 2026
The two girls grew up five blocks apart in Mdantsane township, South Africa, and they were only distant friends until cancer pulled them together many years later. Babalwa Malgas, then 35, had just opened her law office when she learned she had breast cancer. Two years later, her neighbor Tobeka Daki received the same diagnosis. Both were single moms with two boys, and they bonded over their new, shared disease. Malgas said they talked about the “challenges of dating new people — how to explain, whether to disclose prior or not. The common interest of not wanting reconstruction. Fears of leaving our children.”
In 2013, Daki’s oncologist told her she needed a mastectomy, chemotherapy and Herceptin, a cancer drug produced by the Swiss company Roche, to improve her chances of survival. But because of the cost, she couldn’t afford the medication.
As Malgas explained, the two became “sisters” in a campaign against the high cost of cancer medicines. Their yearslong fight brought together various nonprofit advocacy groups that ramped up pressure on the government and Roche to reform patent laws. They picketed outside Roche’s Johannesburg office, demanding the company drop the price of Herceptin, which by 2016 cost around $36,000 for a year’s supply, about four times South Africa’s average household income.
Daki’s cancer eventually spread to her spine, and the 49-year-old health club receptionist died at home in November 2016. Malgas left court early that day to see her friend. “But I was 30 minutes late,” she said.
Daki’s death inspired Malgas and other activists to continue pushing for equitable medical treatment and healthcare justice. Their campaign triggered a government probe into alleged excessive pricing of Herceptin.
“Our slogan was: My cancer, your profit,” said Malgas, whose own cancer returned in the midst of their campaign. “We learned of greed from Roche.” But she said their struggle went beyond Roche.
For many decades, companies making cancer drugs have exploited ethically dubious practices that have generated great fortunes for shareholders but sometimes priced out patients who desperately need the medicines. Now a review of enforcement actions around the world by the International Consortium of Investigative Journalists highlights yet another manifestation of a broken global healthcare system: Some cancer drugmakers face allegations of wrongdoing — again and again — and are not deterred when they have to pay fines or large settlement payments.
Further adding to the industry’s generally wretched reputation, cancer drugmakers have sometimes crossed the line with such documented practices as exploiting the patent system to stifle competition, promoting higher dosages than necessary, taking advantage of industry regulatory shortcuts, and breaching criminal or civil statutes. That’s yet another fallout that can affect patients and raise the expenses of taxpayers and healthcare systems.
This story is a follow-up to ICIJ’s Cancer Calculus investigation, which documented how Merck & Co. kept the price of its blockbuster cancer drug Keytruda high, straining healthcare systems around the world and delaying cheaper versions of the drug from reaching hundreds of thousands of cancer patients in the coming years.
To examine enforcement actions in the cancer drug industry, ICIJ reviewed criminal and civil cases in 31 countries. ICIJ relied on public information and a variety of datasets collated by the nonprofit accountability groups Public Citizen and Good Jobs First, as well as a collection of global anti-competition cases compiled by Brazilian researcher Pedro Gomes Lacerda and Sao Paulo-based lawyer Luiz A. Azevedo de Almeida Hoffmann.
Among the highlights of this review, in the past decade, authorities in seven countries have accused Roche of misleading doctors about a cancer medicine and colluding with another drugmaker. The company paid $14 million to settle charges in Romania that it thwarted competition to three cancer drugs, including Herceptin. An antitrust case in Belgium and the South Africa case of alleged excessive pricing are underway.
For its part, the drug giant Novartis agreed to pay more than $51 million to the U.S. Justice Department in 2020 to resolve kickback allegations regarding the kidney cancer drug Afinitor and another medicine, and pledged to reform its business practices — the third time it had made that promise.
What these companies are doing … they’re basically paying a fee for the license to break the law. –attorney Reuben Guttman
And Celgene Corp., now controlled by Bristol Myers Squibb, paid $280 million to U.S. and state governments in 2017 to settle allegations that it had improperly promoted the medicines Revlimid and Thalomid to treat multiple myeloma, a blood cancer, and a range of other cancers beyond the uses then approved by the Food and Drug Administration. That was one of the largest settlements ever related to a cancer drug. It was the first for Celgene, but not for Bristol Myers, which acquired Celgene in 2019. And for Bristol Myers, it wouldn’t be the last. The New Jersey manufacturer paid $55 million in a multi-state settlement of anti-competition charges relating to a cancer drug in 2003; in 2024 it paid $2.7 million to settle anti-competition charges in Israel concerning yet another multiple myeloma drug.
“What these companies are doing … they’re basically paying a fee for the license to break the law,” said Reuben Guttman, an attorney for the whistleblower whose disclosures led to the $280 million Revlimid settlement.
Bristol Myers did not respond to requests for comment, but its Celgene unit previously denied wrongdoing. Roche has strongly denied it abused its market dominance and called its practices proper and legal. The company declined to comment on ongoing enforcement matters. Novartis said it is committed to operating with integrity and in compliance with laws and regulations.
In all, ICIJ’s analysis of enforcement actions found that between 2010 and 2025, 12 makers of cancer drugs settled 25 cases with authorities in 10 countries. Eleven of those companies paid fines or made settlements totaling nearly $1.7 billion. The alleged violations ranged from deceptive marketing and kickbacks to illegal tactics to block competition and keep prices high.
These payments and fines to settle allegations of wrongdoing barely dent the companies’ revenues, representing just one-third of 1% of the nearly $696 billion the firms accrued in the years the deals were made.
Cancer drug makers’ settlement payments often represent less than 1% of revenue
ICIJ analyzed enforcement actions tied to cancer drugs from 2010 to 2025, as found in SEC filings and annual reports. Percentages compare the settlement amounts paid by the companies to the revenue the drugmakers generated the year of the settlement.
| Company | Cancer drug(s) | Year | Country | Settlement | % of Annual Revenue |
| Clovis Oncology, Inc. | Roci | 2018 | U.S. | $20.0M | 20.97% |
| Celgene Corp. | Revlimid, Thalomid | 2017 | U.S. | $280.0M | 2.15% |
| Astellas Pharma Inc. | Xtandi | 2019 | U.S. | $100.0M | .84% |
| Novartis AG | Gleevec, Tasigna | 2015 | U.S. | $370.0M | .73% |
| Roche Group | Avastin | 2020 | France | $454.2M | .71% |
| Incyte, Corp. | Jakafi | 2016 | U.S. | $12.6M | .42% |
| Astellas Pharma Inc. | Tarceva | 2016 | U.S. | $33.5M | .27% |
| Roche Group | Avastin | 2014 | Italy | $123.6M | .23% |
| Aspen Pharmacare Holdings Limited | Alkeran, Leukeran, Purinethol, Thioguanine | 2016 | Italy | $5.9M | .19% |
| Roche Group | Avastin | 2020 | France | $70.5M | .11% |
| Amgen, Inc. | Kyprolis | 2019 | U.S. | $24.8M | .11% |
| Novartis AG | Afinitor | 2020 | U.S. | $51.3M | .10% |
| Astellas Pharma Inc. + Roche Group* | Tarceva | 2016 | U.S. | $67.0M | .10% |
| Bristol Myers Squibb Co. | Revlimid, Thalomid | 2020 | U.S. | $34.0M | .08% |
| Roche Group | Tarceva | 2016 | U.S. | $33.5M | .06% |
| Eli Lilly and Co. | Gemzar | 2015 | Brazil | $11.9M | .06% |
| Pfizer, Inc. | Sutent, Inlyta | 2018 | U.S. | $23.9M | .06% |
| Roche Group | Rituxan | 2011 | U.S. | $20.0M | .04% |
| Roche Group | Mabthera, Herceptin | 2019 | Romania | $10.3M | .02% |
| Novartis AG | Avastin | 2023 | Belgium | $3.0M | .006% |
| Roche Group | Tarceva | 2019 | Romania | $3.7M | .006% |
| Bristol Myers Squibb Co. | Imnovid (Pomalyst) | 2024 | Israel | $2.7M | .006% |
| AstraZeneca Plc | Zoladex | 2022 | South Korea | $767.0K | .002% |
*The $67 million 2016 Tarceva settlement amount was split evenly between the drugmakers for the purpose of these calculations. In some cases, non-cancer drugs were also part of settlements. Cases that resulted in no settlement payment are not included in this visualization.
For more information, see ICIJ’s Cancer Calculus here, https://projects.icij.org/investigations/the-cancer-calculus/charts/.
Reshma Ramachandran, an assistant professor at Yale School of Medicine, has studied kickbacks in the pharmaceutical industry. She said the settlements are “effectively a slap on the wrist that the companies largely ignore.”
“As they amount to just a fraction of their revenues, there’s little incentive for the companies to change behaviors,” she said. “They just account for this as the cost of doing business, regardless of the harms it brings to patients.”
The cancer drug-related settlements reviewed by ICIJ are only a small part of the overall cases these companies resolved. Eleven of the 12 firms accumulated $15.4 billion in total healthcare fines and settlements from 2010 to 2025, according to data gathered by Good Jobs First. The drugmakers posted more than $491 billion in revenues just in their latest fiscal year.
The haze of settlements and fines leaves cancer survivors like Babalwa Malgas of South Africa and Beth Kitchin of Birmingham, Ala., reeling from the consequences.
Kitchin, 62, a retired professor of nutrition, loved to jog and hike, practiced yoga and was healthy until an MRI in 2021 revealed tumors in her legs that turned out to be a type of leukemia. She received a stem cell transplant, but when it led to a serious side effect — donor cells began attacking healthy cells — her doctors prescribed a costly medicine called Jakafi.
During an interview, she held up a bottle of “teeny, tiny” pills. “That’s like a $300 pill right there,” she said. “It’s a game.” Although her insurance covered most of the cost, Kitchin said she had substantial out-of-pocket expenses.
Incyte Corp., the Delaware-based maker of Jakafi, agreed in 2021 to pay $12.6 million to resolve Justice Department allegations that it paid kickbacks to a charitable foundation to increase prescriptions of Jakafi by covering the copays of patients who were ineligible for the drug. Incyte did not return requests for comment but previously denied wrongdoing. Kitchin said she was unaware that the medicine had been subject to an alleged violation until talking to ICIJ.
With their medical breakthroughs and lifesaving treatments, pharmaceutical companies have brought hope to many. But the frequent rule breaking and illegal conduct show a troubling glimpse of what healthcare has become. As cancer rates climb throughout the world, the giants of an industry poised to save lives have become increasingly, if not untouchable, unstoppable in putting profits before patients.
‘Profits over following the law’
ICIJ’s review found that cancer drug companies that paid fines or made settlement payments rarely admitted to wrongdoing. Instead, if they settled, their explanations sometimes centered on wanting to avoid lengthy, expensive litigation.
The review revealed that there are few penalties, if any, in cancer drug cases more severe than civil and criminal fines. Rarely are individual directors or officers held accountable, and no pharmaceutical company in ICIJ’s review appears on several lists of firms barred from government business.
In a few cases, authorities overturned or reduced penalties, or companies paid no fine at all. Merck, for example, avoided a fine in Austria after allegations that the company engaged in anti-competitive behavior relating to a brain cancer drug. Fifteen years earlier, Schering-Plough Corp., which Merck later acquired, pleaded guilty to conspiracy to settle a U.S. case citing the same drug.
Rick Claypool, research director at Public Citizen, a nonprofit watchdog group, said “apparent repeat offenses” by the largest pharmaceutical companies are evidence of weak enforcement. “We see this pattern again and again,” Claypool said. “If corporations don’t face consequences for violating the law — or if the consequences are costs that are easily absorbed — then corporations will prioritize profits over following the law.”
In 2022, a separate ICIJ investigation found that the growing global scale of corporate leniency agreements allowed large companies in virtually all industries to avoid serious punishment for criminal and civil violations. Settlements known in the U.S. as deferred prosecution agreements and non-prosecution agreements often resulted in repeat offenses and rarely involved punishment of senior executives.
Source: International Consortium of Investigative Journalists, https://www.icij.org/investigations/cancer-calculus/big-fines-and-settlements-barely-dent-cancer-drugmakers-revenues-fail-to-deter-wrongdoing/