Mark Cuban says many of the customers flooding his low-cost pharmacy have something in common: they already have insurance, and they are still better off paying cash.
“They come to us because our cash price is often lower than what their insurance plan asks them to pay,” Cuban told Texas House lawmakers. “That tells you something is wrong.”
The billionaire cofounder of Cost Plus Drugs and former Shark Tank star used the hearing to set out five steps to fix America’s healthcare affordability crisis, which has left a record 51 per cent of US adults unable to reliably afford quality care, according to West Health-Gallup. Many of his remedies share a common ingredient: transparency.
First, Cuban wants insured patients to be able to choose the cheapest option without penalty. If a prescription costs $500 through insurance but $100 through Cost Plus Drugs, patients should be able to take the cheaper route and have that spending count toward their deductibles and out-of-pocket maximums. “Patients should be rewarded for saving themselves and their health plan money. They shouldn’t be punished for it,” he said, calling this the price competition that healthcare “desperately needs”.
Second, he is pushing for standardized contracts for pharmacy benefit managers (PBMs) and third-party administrators. Three PBMs, CVS Caremark (CVS), Cigna’s (CI) Express Scripts and UnitedHealth’s (UNH) OptumRx, handle roughly 80 per cent of US drug claims. Their contracts can run to hundreds of pages, making harmful terms easy to bury. “I call it contractual terrorism,” Cuban said. He has drafted a model contract that states, cities, counties and school districts could use as a template. “Just stop making every government entity negotiate these contracts from scratch,” he said. “It’s a losing game for everybody.”
Third, Cuban argues that pricing should be public wherever taxpayers foot the bill. Any taxpayer-funded program, including Medicare and Medicaid, should be required to disclose data such as rebates, fees, guarantees and affiliate compensation. Without such price discovery, he said, a market cannot function efficiently when one party holds all the information.
Fourth, he wants gag clauses eliminated. These provisions stop employers and plan sponsors from openly discussing their contract terms, which Cuban said prevents them from comparing fees and negotiating better deals.
Fifth, he called for enforcement with real teeth. Regulators could go easy on a first significant violation, he said, but should hit repeat offenders with much steeper penalties. Under the current system, “some of these companies can make billions, get caught, pay a fine” and “write it off more easily than I wrote off my NBA fines”. He added: “That’s not deterrence. That’s a cost of doing business for them.”
Cuban’s crusade on drug prices has produced some strange bedfellows. In May, TrumpRx, the White House-backed discount drug website, added more than 600 generic medications through Cost Plus Drugs, alongside Amazon (AMZN) Pharmacy and GoodRx (GDRX). The arrangement put Cuban on the same side as President Donald Trump, who called him “a loser” during the 2024 campaign.
Cuban also backed the Break Up Big Medicine Act in March, put forward by another odd couple: Republican Senator Josh Hawley of Missouri and Democratic Senator Elizabeth Warren of Massachusetts. The bill would bar a single company from owning both an insurer or PBM and medical providers. It has been referred to the Senate Judiciary Committee but has not advanced. Cuban has kept pressing the case, recently arguing that rising healthcare costs, not artificial intelligence, are the real threat to American jobs.