Mark Cuban sees two paths to fixing healthcare economics: Break up the largest vertically integrated insurers, or teach the employers who fund most private coverage to act like real buyers.
The co-founder of Mark Cuban Cost Plus Drug Co. outlined his thoughts in a Nov. 5 conversation at Becker’s CEO + CFO Roundtable.
Breaking up ‘Big Medicine’
The three largest pharmacy benefit managers — Express Scripts, CVS Caremark and Optum Rx — together handle 80% of U.S. prescription claims. Asked whether those companies can be “reformed,” Mr. Cuban pointed to the Break Up Big Medicine Act, introduced in February by Sens. Elizabeth Warren, D-Mass., and Josh Hawley, R-Mo. The bill would bar a company from owning both an insurer or PBM and a provider or management services organization. Mr. Cuban publicly backed the bill in March.
Mr. Cuban said UnitedHealth Group has 3,000 subsidiaries and conducts $150 billion in intercompany transfers each year.
“They have so many companies and so much control of the industry; they basically get to do what they want,” he said. “So I think they need to be broken up.”
If that does not happen, he said, change has to come from self-insured employers. According to a KFF survey, 63% of covered workers across all industries were in self-funded plans overall in 2024.
Mr. Cuban said those employers carry the financial risk but often do not realize that they control the third-party administrators processing their claims, he said. He urged employers to run their contracts through AI and require that any cheaper care that employees find on their own count toward deductibles and out-of-pocket maximums.
“If those self-insured employers knew what they were doing, the whole industry would change overnight,” he said.
What GLP-1s reveal
Mr. Cuban said drugmakers’ moves to sell GLP-1s directly to patients show how much PBMs add to costs. Eli Lilly and Novo Nordisk have cut self-pay prices through direct channels such as LillyDirect and NovoCare.
“When you see Lilly and Novo selling direct to patients, it’s not because they want to sell direct. It’s because it’s the only way to work around the PBMs,” Mr. Cuban said, who added that selling direct lets the companies avoid PBM rebates and fees.
The state of Cost Plus Drugs
Nearly five years after launching CostPlusDrugs.com in January 2022, Mr. Cuban said the business is setting records daily. The site lists its cost and a flat 15% markup for the roughly 4,500 drugs it carries.
Its wholesale arm, Cost Plus Marketplace, now sells to about 300 hospitals, he said, including Franklin, Tenn.-based Community Health Systems.
Mr. Cuban added that brand-name drugs remain largely off the platform because the big three PBMs have warned manufacturers that working with Cost Plus could hurt formulary placement across their portfolios.
He expects the company’s tractor-trailer-size manufacturing pods, which can be shipped to disaster zones and configured for different drug types, to become “our biggest business by far.”
