Mark Cuban: Mixing Up the Pharmaceutical Landscape

“Mark Cuban has a megaphone, and he gets the word out much bigger, better than policy think tanks or companies like Costco,” says Dr. Popovian. “I think his visibility is what’s important here, not what he’s technically doing because there are other people that are better established in this market.”

For years, physicians have complained about obstacles constructed by PBMs that make it difficult to get needy patients affordable prescription medications, says Michael Schweitz, MD, a rheumatologist and action network president of Alliance for Transparent and Affordable Prescriptions (ATAP). Dr. Schweitz is optimistic that Mr. Cuban can shake up the world of powerful PBMs and bring more accountability to that industry, a stated goal of ATAP.

“He gets it,” says Dr. Schweitz. “That’s really important. No one in the policy world, no one in the business world really understood the activities of PBMs, what they did and how many dollars they took out of the system and what kind of shenanigans, I’ll say, they were involved in. So it’s good to see someone of importance and someone in a very visible large business environment come out and talk about, in detail, his understanding of the egregious activities of PBMs.”

PBMs work for health insurance companies and operate on a large scale, which allows them to negotiate lower prices and discounts for prescription medications. Often, the price breaks are from rebates that drug companies offer to get their medications on prime positions of drug formularies.

Yet prescription drug costs keep rising, along with public pressure on PBMs to be more transparent about pricing practices. For example, a patient may be unaware that a visit to the pharmacy for a prescription could be cheaper if paid for with cash, instead of paying a health insurance copayment.

Dr. Schweitz

“One of the things that is missing in the United States is that patients don’t know what the price is going to be for their out-of-pocket costs when they walk into a pharmacy or physician’s office or hospital,” says Dr. Popovian. “It’s a mystery.”

PBMs were formed years ago initially to get patients better deals on the skyrocketing cost of prescription drugs, says Dr. Schweitz. They set out with a rational purpose, to control costs for insurance companies and help manage the supply of increasingly expensive medications to make sure they got to patients who needed them, he says.