Keytruda (pembrolizumab): what Medicare Part D spends and the dated federal facts we hold

Medicare Part B payment limit

CMS publishes a quarterly payment limit for the HCPCS code that its NDC crosswalk links to Keytruda. It is a ceiling for providers who bill Medicare Part B, not a price a patient pays, and a code's presence says nothing about whether Medicare covers a product.

Source: CMS ASP pricing files (october-2026-medicare-part-b-payment-limit-files-final.zip and the matching NDC-HCPCS crosswalk). CMS ASP pricing files page.

Medicaid use by state

CMS's State Drug Utilization Data records, for 2025, how many prescriptions each state's Medicaid program paid for under this drug's packages and what it reimbursed. The 4 states with the largest reimbursement are shown. Reimbursement is before the rebates manufacturers pay states, so it is not a net cost and not a price a patient pays.

Explore every state, both years and the per-prescription figures for this drug in the Medicaid by state explorer.

Where the publisher suppresses small managed-care cells, a state's figure covers fee-for-service claims only and understates use (3 state and package figures are marked that way here). A state missing from the table means its figures were suppressed or not reported, not zero use. 90 older-year figures are held and left out of the table.

Source: CMS State Drug Utilization Data (State Drug Utilization Data 2025, modified 2026-07-13T15:28:32Z), read November 7, 2026. CMS dataset page. State-reported data compiled by CMS; aggregate by state and package, no provider or patient data.

Where help paying exists

Programs in our finder that list pembrolizumab. Each shows its income ceiling, when we read it and whether we checked it against the program's own document. Eligibility is decided by the program, not by us.

• Merck Helps (Merck Patient Assistance Program) manufacturer
  Income at or below $79,800 for one person for KEYTRUDA, or $63,840 for JANUVIA and JANUMET
  

  Program website. Our guide to this program.

• Keytruda Patient Assistance (Merck) manufacturer
  Income at or below $79,800 for one person, $108,200 for a couple (500% FPL)
  

  Program website. Our guide to this program.

• HealthWell Foundation nonprofit
  Up to 300% to 500% FPL depending on the disease fund; many funds close to new patients
  Ceiling matched against the program's page text, November 6, 2026.

  Status. The HealthWell Foundation homepage lists disease funds as Open or Closed when read. Closed funds include Type 2 Diabetes, Migraine and Multiple Sclerosis - Medicare Access; open funds include Multiple Myeloma - Medicare Access, which the page says offers up to $8,000 in prescription drug copayment or Medicare Part B premium assistance. The page carries no fund-level date; the status is as of the read. (read November 7, 2026)

  Program website. Our guide to this program.

• Good Days (formerly Chronic Disease Fund) nonprofit
  Income at or below 500% of the poverty level
  Figure not yet re-read on the program's own page.

  Program website.

Check where your income sits against each ceiling: open the assistance finder. See what has changed and when we last verified each program on the program status board.