It is one of the most common components of emergency medicine: an intravenous bag of sterile saltwater. 
 
 Luckily for anyone who has ever needed an IV bag to replenish lost fluids or to receive medication, it is also one of the least expensive. The average manufacturer’s price, according to government data, has fluctuated in recent years from 44 cents to $1. 
 
 Yet there is nothing either cheap or simple about its ultimate cost, as I learned when I tried to trace the commercial path of IV bags from the factory to the veins of more than 100 patients struck by a May 2012 outbreak of food poisoning in upstate New York. 
 
 Some of the patients’ bills would later include markups of 100 to 200 times the manufacturer’s price, not counting separate charges for “IV administration.” And on other bills, a bundled charge for “IV therapy” was almost 1,000 times the official cost of the solution. ||||| A new report suggests drug makers are profiting from the waste. - Peter Macdiarmid/Getty Images 
 
 Patients, insurance companies and the federal government are on track to spend about $3 billion this year on cancer drugs that will be thrown away, according to a report on pharmaceutical company profits in BMJ – formerly known as the British Medical Journal – that was released Tuesday. 
 
 At the same time, drug makers, hospitals and doctors are profiting from the way these drugs are packaged, researchers found. 
 
 At his office at Memorial Sloan Kettering in Manhattan – a leading cancer center – Dr. Leonard Saltz shows off a drug. 
 
 “So this is a box that contained a vial of Keytruda at 100 mg,” he said. “About the size of a small salt shaker. So this would cost approximately $5,000, a little bit over.” 
 
 Keytruda is part of a new wave of promising oncology drugs. It mobilizes your immune system to fight the cancer for you. 
 
 “There is no question that this is a drug we want to have available for our patients,” Saltz said. 
 
 But Merck packages this valuable drug in only one size in the U.S.: 100 mg. 
 
 The typical patient needs 150 mg, which means half of the second vial is thrown away. 
 
 “It’s going to cost in excess of $5,000, and you have a situation where each time you treat the patient you need to put half of it in the trash,” Saltz said. 
 
 Saltz – one of the study’s authors – said at this rate Merck is in line to be paid more than $1 billion dollars over the next five years for leftover drugs that aren’t used. 
 
 The report names Eli Lilly, Genentech, Amgen and Bristol-Myers Squibb among others that package top-selling cancer drugs in a limited variety of sizes that causes waste. 
 
 “We don’t stumble across areas very often where we can be 100 percent confident patients are not benefitting,” said Dr. Peter Bach, lead author of the report. 
 
 He says companies are taking advantage of ambiguous if not contradictory regulations on packaging size. 
 
 Using Keytruda as an example, Bach says while Merck makes the 100 milligram doses here, the company sells 50 milligram does in European countries. 
 
 “Serious thought is going into how big the vials should be and these are highly skilled, sophisticated companies who understand the sources of their revenues,” he said. 
 
 Bach said drug companies could either produce a variety of dose sizes or refund the cost of leftover drugs. 
 
 Merck said it’s moving to a fixed dose 200mg size that will eliminate waste. 
 
 In a statement, Amgen said offering additional vial options is misguided and threatens patient safety. 
 
 Takeda Pharmaceutical Company and Genentech declined to comment for this story.
– As far as price tags go, it's an attention grabber: $546 for six liters of water and 54 grams of salt. But that's what one patient was charged for what the New York Times calls "one of the most common components of emergency medicine": the IV bag. Nina Bernstein digs into the numbers by way of a 2012 food poisoning outbreak in upstate New York. She reviewed some of the more than 100 affected patients' bills, and quickly realized that some were charged as much as 200 times the manufacturer's price for a liter of saline—which has recently ranged from 44 cents to $1—plus another change for "IV administration." A patient at White Plains Hospital got a bill that included $91 for a single unit of Hospira IV (hospital's cost: 86 cents), plus $127 for administering it. The $546 figure comes from the bill of a woman who spent three days in the same hospital, which paid $5.16 for her six liters of saline. Bernstein acknowledges we're pretty numb to the reality of inflated health-care costs, but sees something more in "the tale of the humble IV bag": "secrecy that helps keep prices high." It's the product of purchasing organizations and distributors and other players who make deals that "so obscure prices and profits that even participants cannot say what the simplest component of care actually costs, let alone what it should cost," she writes. "And that leaves taxpayers and patients alike with an inflated bottom line and little or no way to challenge it." Read her full piece here.