Mark Cuban on Starting an Online Pharmacy
Mark Cuban was horrified by how many Americans struggle to afford medications, so he’s doing something about it.
Sixty-two percent of American adults are taking at least one prescription drug and a quarter take four or more prescription medications. Many people struggle to pay for their meds, which are 250% more expensive in the US than other OECD nations. And we know that cost is one of the major barriers for medication adherence.
Recently, billionaire investor, Dallas Mavericks owner, and Shark Tank star Mark Cuban launched an online pharmacy for generic drugs that offers steep discounts over traditional pharmacies. The Mark Cuban Cost Plus Drug Company cuts out the middle-men and charges a transparent and simple price which is equal to the manufacturers' price plus a flat 15% markup.
In this episode, we got a chance to learn more about Mark’s vision for a more equitable healthcare system.
Topics covered:
The role Pharmacy Benefit Managers (PBMs) play in the high cost of prescription drugs
How administration costs make up 21% of healthcare costs every year
Why he decided to start, and fund, this company — and why no one has done this before
What medications they plan to offer in the future
Why they focus on cash-pay patients and don’t take insurance
Listen
Transcript
[00:00:00] Halle Tecco: My favorite thing about working in healthcare is the
people this industry brings together brilliant, highly motivated individuals who
are driven by the opportunity to make a difference. My name is Hall Techo, and
this is The Heart of Healthcare, a podcast where I'll be introducing. To the
people on the ground moving the needle in public health and medicine.
[00:00:36] Mark Cuban: More than three dozen drug companies have already
hiked prices in the new year. The average hike is 6.3%, nearly three times the
rate of inflation. The price of insulin. A life saving drug for diabetics tripled
between 2002 and 2013. The next time you go to the drug store, you might be in
for sticker shock.
[00:00:55] Drug companies have quietly raised the. On hundreds of
medications, drug prices in this country have been soaring largely because our
government, for the most part, does not negotiate the price of medication. That
means pharmaceutical companies could charge whatever they want right now,
right here in America, we pay the highest prescription drug cost of any
developed nation in the world.
[00:01:16] Let me say that again, Of any developed nation in the.
[00:01:22] Halle Tecco: 62% of American adults are taking at least one
prescription drug and a quarter take four or more. Many people struggle to pay
for their meds, which are 250% more expensive in the US than other O E C D
nations, and we know that cost is one of the major barriers for medication
adherence.
[00:01:42] Recently, Billionaire Investor Dallas Maverick, owner and Shark
Tank Star Mark Cuban, launched an online pharmacy for generic drugs that
offers steep discounts over traditional pharmac. The Mark Cuban Cost plus drug
company cuts out the middle men and charges a transparent and simple price,
which is equal to the manufacturer's price, plus a flat 15% markup.
[00:02:03] Today I'm excited to talk to the founder himself, Mark Cuban.
[00:02:10] Mark, welcome to the Heart of Healthcare. Thanks for having me.
You are a prolific investor, so I'm gonna start by turning the tables on you. Give
me your quick shark tank elevator pitch for the Mark Cuban cost plus drug
company.
[00:02:24] Mark Cuban: Okay. Generic, jus cheaper than you can get them
anywhere. Hopefully lower than your co-pay and it more accessible than you've
been able to get.
[00:02:34] Why hasn't anyone else done this? Because of the nature of the
healthcare industry, which you guys know very well with PBMs. There's just,
yeah, an INS sensuous business where there's so much money involved that
people that have tried to become the low-cost provider, it's very difficult
because at the same time, more often than not, you wanna maximize your
profits and you wanna maximize your scale.
[00:02:58] And those three things aren't necessarily.
[00:03:00] Halle Tecco: How do you anticipate the incumbents, including the
PBMs, Walmart, and others to respond?
[00:03:06] Mark Cuban: It just depends how big we get. I think they're looking
at all this now and saying, um, okay, you know, he's just a pimple and not even
really an annoyance yet. Let's see what happens next.
[00:03:18] And from there, it'll just depend on how big we get. Um, but the
reality is there, there's only a, you know, a limited amount of things that they
could do, and all of them would be. You know that
[00:03:29] Halle Tecco: they're sending this around internal memos, looking at
what's, what's happening over
[00:03:33] Mark Cuban: here? Yeah. Would you know, who knows?
[00:03:34] They might not even care at this point, but, um, you know, that's
fine. I'm good either way. And look, the reality is if everybody came in and
matched our price, we're still gonna stay in business. And so if we're still in
business, they have to keep matching our price, which means that's just great for
the, for all patients every.
[00:03:52] Halle Tecco: Absolutely. So you're not alone though, in being
outraged at the cost of prescription drugs. There was a study that showed that
83% of adults say that the cost of prescription drugs are just unreasonable. Of
course. Are you serving everyone? Are you looking for uh, people who are
specifically underinsured?
[00:04:10] Uninsured, Those who just like a
[00:04:12] Mark Cuban: good deal. Whoever wants to pay cash. Yeah. We'll
serve anybody who wants to pay cash. Our goal is to be the low cost provider,
so we're not gonna have the bells and wish whistles of others. Um, we're not
gonna, you know, try to bend over backwards to have the leading doctors, you
know, write blog posts on our website.
[00:04:29] None of those things. Mm-hmm. , our goal is to be the low cost
provider because the mission is whatever your cost is plus a dollar, there's
somebody who now can't afford it. Yeah. And so we're trying to stay as low as
we possibly.
[00:04:44] Halle Tecco: Will you have access to pharmacist if a patient wants
to talk to a pharmacist?
[00:04:47] Mark Cuban: Yeah. We're, we're partnered with True Pill and so,
um, they're a full pharmacy. Great.
[00:04:53] Halle Tecco: You've been working on this for a few
[00:04:54] Mark Cuban: years. Yeah, it's three, four years now. I forget
exactly how long it's been. So this isn't not just a whim, it's not something you
say, Hey, let's just, you know, start it and we'll be up and running in three
weeks.
[00:05:04] Yeah. Um, it's taken multiple years. Obviously there's a lot of
regulatory issues. You've got to, um, show manufacturers what we're doing. We
had to demonstrate to True pill and integrate with True Pill and develop the site,
you know, all the elements that go with. running a site that sells drugs. Yeah,
[00:05:23] Halle Tecco: and it just launched last week.
[00:05:25] Correct. So, what's been the response so far from customers? Insane.
[00:05:29] Mark Cuban: Insane? Yeah. . Um,
[00:05:32] Halle Tecco: who are they? Can you tell me about the demographic
so far? We
[00:05:34] Mark Cuban: don't know cuz we don't ask. Okay. You know, and
we can't, for HIPAA reasons, we can't go through and try to analyze it and we
won't go through. But you know, we're getting 10,000 plus signups a day.
[00:05:45] Halle Tecco: Amazing. Do you think that the folks who have not
bought online are going to shift from going to their local pharmacy to buying it
online? I
[00:05:54] Mark Cuban: think most will not. And that's okay, right? Mm-
hmm. , not everybody's gonna be in the same financial situation, and so, you
know, some people are, will put a premium on convenience.
[00:06:03] You know, you're driving home and there's. The Walgreens or cvs,
I'm gonna go through the drive through and pick it up and there's nothing wrong
with that. We're fine with it. Mm-hmm. and then other people are gonna put a
premium on, um, paying the lowest possible price. If you fit into that profile,
then where, you know, come to cost plus drugs.com, we're gonna give you the
best, the best price.
[00:06:23] Halle Tecco: Yeah. But I imagine that how people think about
convenience has changed since Covid, because now actually going into a store
is .
[00:06:30] Mark Cuban: Yeah. Without question. Right? It's sometimes it's
easier if it just shows up, um, with, in the mail. And, and we obviously have
seen that with our signups, um, because we're, we're very transparent, you
know, you know what you're gonna pay for and you know, you know it's gonna
be delivered via.
[00:06:45] Halle Tecco: So, I mean, many people struggle to pay for their
meds. We pay 250% more than other O E C D nations for our medications. This
is something that has long been broken. You knew when you started that this
was a broken industry, of course. What have , what have been some shocking
moments in the last three years as you've built this
[00:07:06] Mark Cuban: PBMs, you know, and how ingrained they are and
trenched they are, and how much money they spend.
[00:07:14] Halle Tecco: Can you explain what PBMs do
[00:07:16] Mark Cuban: for our listeners? Yeah. Pharmacy Benefit Manage
Manager is an organization that acts as an intermediary effectively between
manufacturers of drugs and insurance companies, and their job is to. Represent
the manufacturers and get the insurance companies to carry those drugs.
[00:07:37] If you're a drug manufacturer, you want to be on the product list of
an insurance company because if they won't approve you, then you won't have
any sales to that insurance company, and the pharmacy benefit manager works
out the deals to. The drugs on the product list for the insurance companies. And
in doing so, there's a lot of money that changes hands.
[00:08:04] And so the pharmacy benefit managers get the manufacturers to pay
them rebates on the sales that are made through the insurance company as their
way of making money. And so because. Even though a drug may be costed a
dollar, if there's a $5 rebate, the insurance company's gotta sell it for six. And if
there's no rebates and they're outside that system, which is what we're trying to
do, we can sell it at our cost of a dollar plus a 15% markup.
[00:08:35] And actually if it costs us a dollar, we round it up to $2. So, uh, it's,
you know, and then we charged, um, a $3 handling fee and a $5, um, um,
shipping.
[00:08:48] Halle Tecco: Yeah, having that transparency is, Groundbreaking
though, unfortunately. Uh, will you guys, will you guys be on Good Rx where
people can search and, and see this is an option That's
[00:08:58] Mark Cuban: up to them.
[00:08:59] Yeah. Okay. We're, we're working on a, um, a honey like chrome
extension with a group called cultivate.us. They're so that you'll be able to just
have the extension and when you look at any drug on any site, our, our pricing
will be there as an option. Yeah.
[00:09:15] Halle Tecco: Interesting. So I'm trying to think of an analogy and I
wonder if you've already figured out one for like who the PBM.
[00:09:22] Like, are they the bouncer at
[00:09:23] Mark Cuban: the club? Like Yeah. That you have to pay 50 bucks
to get in. Yeah. Yeah. That's the way they're working. . Yeah. There's, there's
always a cover charge, right? Yeah. There's a cover charge to get into the
insurance company's formulary is what they call it, Um, so that they'll sell it to
their customers.
[00:09:38] And so it's just, it's unfortunate and it really creates a, a significant
distortion in pricing, particularly for drugs like insulin. You know, the cover
charge, if you will, from the PBMs, has gone up, I think I read something
yesterday from 3% of the price to effectively 50% of the price of
[00:09:56] Halle Tecco: insulin. And do other countries not have PBMs?
[00:09:58] No. That's really one of the main factors for our costs here. Yeah.
Without question. Yeah. Interesting. Okay, so 80% of prescriptions in the US
are generics, so it makes sense that you guys started there. Right. Do you have
plans to offer branded scripts
[00:10:12] Mark Cuban: in the future? Not at this time. Yeah. We wanna win
the battle.
[00:10:15] We're in first, right? Because Yeah. You know, there's, there's a cost
associated with dealing with all those. It's not, not to say that we won't do it,
right? If someone came to us and said, Look, your cost, we'll sell you this
branded drug at X dollars. . Um, and our cost plus 15% is dramatically lower
than is offered elsewhere.
[00:10:34] Yeah. We'll sell it for sure. So we're not opposed to it, we're just not
expecting it to happen much. Yeah. So
[00:10:40] Halle Tecco: you have have direct relationships with the
manufacturers, with the drug
[00:10:43] Mark Cuban: companies? Correct. In, in most cases there's some
DIS distributors, but in most cases, manufacturers. And what's their response
been so far?
[00:10:50] Well, they, they, they didn't know what to expect, but, you know, my
money was green and they knew I had enough of it, , and so they were willing
to take it. And now they're starting to see, based off the response that this is, this
could be really big.
[00:11:02] Halle Tecco: Yeah. This is the future. They don't have to go
[00:11:04] Mark Cuban: through the PBMs.
[00:11:06] Well, they'll still have to, cuz we're not dealing with insurance at all.
So if you've gone through your deductible and you don't have a copay Yeah.
And then you're better off going through an insurance company, um, if you,
regardless of your deductible, if your copay is 20 and our price is 15, it's
cheaper to go through us.
[00:11:25] Um, even though, you know, you can make an argument that you're
not using up your deductible, um, but you, you know, everybody's able to do
their own math. Yeah. I, I
[00:11:33] Halle Tecco: imagine though, at some point insurance companies
might look at this and say, Okay, well if you can get it cheaper, then we can get
it for you.
[00:11:40] We'll reimburse you for that cost. No, they never
[00:11:42] Mark Cuban: will. You don't think they will? Why not? No,
because. They're in bed with the bouncers. Yeah. Yes, they are. Um, they don't
necessarily like the, the pharmacy benefit managers that they don't own, but a
lot of them own their own pharmacy benefit managers. Ah. And so, yeah.
[00:11:57] So yes, they are, they are in bed with the bouncers, you know, they
call them payers, right? They, they call the, um, insurance company's payers and
the hospitals and doctors' providers. And the way it works is their margins are
pretty much constant. Um, and so they're higher, their revenue, the more money
they make.
[00:12:15] And that's the same for hospitals. And so they're, they, they have a
lot of incentives to help get their customers healthy, but they don't have any
incentives to make it at the lowest possible.
[00:12:26] Halle Tecco: Yeah, Which is, It's too bad because the patient
benefits from that the
[00:12:30] Mark Cuban: most. Yeah. I mean, look, you want, you want them
to be healthy first and dollar second, but for a lot of people, way too many
people, that's not a binary choice, right?
[00:12:40] Yeah. It's not an either or. If you can't afford the medication or you
don't have insurance and don't have any opportunity to pay for the medication,
then you. , that's deadly for a lot of people and that's where you see people
rationing their, their medicine and or choosing to go without eating to pay for
their medicine and just outcomes that are just awful.
[00:13:00] Yeah, and so that's a key reason why we started cost plus drugs.com.
[00:13:05] Halle Tecco: What about Medicare and Medicaid? They definitely
don't own a
[00:13:07] Mark Cuban: pbm. They do. And they don't. Right? Because they
can't just negotiate the best possible price. And that's just been a big point of
contention, right? Mm-hmm. , why can't Medicare and Medicaid just go and
negotiate the lowest possible price?
[00:13:19] Yeah. And they can't,
[00:13:21] Halle Tecco: but they could. They could reimburse people from
buying on
[00:13:23] Mark Cuban: off your site. Yeah, but just the administration costs.
One of the big issues that the country has in terms of of costs is that, you know,
there's so many different types of insurance deals between insurers and hospitals
and doctors that, and they change 'em every year for the most part, that the cost
of administering all these different things that we're talking about.
[00:13:48] Is 21% of the total healthcare cost in this country every single year.
It's bonkers, which is insane, and, and so. That's the way these incumbents do
their business. Yeah. And so that's one of the reasons that there's an opportunity
for us, and you know, it's also why there's not gonna be reimbursement because
the administration costs are just so outrageous.
[00:14:10] Now, what we will be able to do is work directly with companies
that self-insure, that companies that, um, have their own PBM and are looking
for lower, um, sources of product. Yeah. And so there, there are some options,
right? They're not all bad except for us, and so we'll just see how it all plays out.
[00:14:29] Halle Tecco: Are there any groups in particular that you guys are
interested in partnering with?
[00:14:33] We'll
[00:14:33] Mark Cuban: partner with anybody, right? As long as you know,
you facilitate, um, having the lowest available price for patients, we we'll be
your best friend. Yeah. That's all we care about. Everything else is mishegoss.
It's, it's, I.
[00:14:52] Halle Tecco: We'll be right back after the break.
[00:15:10] What else, um, do you think needs fixing in our healthcare? What
else could you, what else can you cost plus? Oh, that's
[00:15:16] Mark Cuban: a long, long list. Yeah. You know, I don't know that
we're gonna try to get into all the other stuff that cost plus because we gotta win
the battle we're in. You know, like I said earlier, the bigger we get, the more
aware everybody's going to be about us.
[00:15:31] And so we have to anticipate that and, you know, in can. Scaling up
with True pill to be able to handle what hopefully will be a large volume of
customers. Yeah. That, that takes a lot of work. And so, you know, we, we've
got to accomplish that because the worst thing we can do is not make our
existing customers happy.
[00:15:50] Yeah.
[00:15:50] Halle Tecco: How are you making them happy other than the lowest
[00:15:53] Mark Cuban: cost, doing the job, lowest price. I mean, that's it.
That's enough. Yeah. That's it. Because everything else that you try to do adds
cost. Yeah. I mean, you guys see, when you do a podcast, right? You want to
add this feature, you wanna add that feature, it all costs money.
[00:16:07] Of course. Multiply that times 10 when it comes to dealing with
drugs and healthcare. And so our entire mission is to be the low cost provider.
Yeah. You never know what that inflection point for somebody is where they
can't afford their. And so all we care about is being the low cost providers now,
we'll never, you know, do anything to impact the quality of the drugs.
[00:16:32] And we test and all that information is available that's legally has to
be available, all that stuff. So quality is job one. There's an old commercial.
Yep. But at the same time, our mission is to be the low cost provider because
the look on somebody's face when they know they can get their child, the
medicine that they.
[00:16:53] And still have everybody. Dinner is a lot more important to me than
the look on someone's face because they were able to, you know, read an article
on the website. That's not a fit for everybody, but for all the people who really
need to get their drugs as inexpensively as possible, that's us. Cost plus
drugs.com.
[00:17:14] Halle Tecco: I did a podcast recently around the national security
threat around generics because they are moving overseas and having that supply
chain be so vulnerable is concerning to some folks. Yep. What are, what are
your
[00:17:27] Mark Cuban: thoughts around that? I agree, right? Yeah. And so,
you know, you never want to have that dependency.
[00:17:32] We're building a manufacturing. In Dallas that, um, we'll, we'll build
Wow. Each injectables there to start. Okay. And hopefully that'll be done by the
end of the year and if we get trash in there, we'll expand it and then hopefully
we'll be able to do more manufacturing in Dallas. Wow.
[00:17:49] Halle Tecco: What will
[00:17:49] Mark Cuban: you be making there?
[00:17:50] Um, I don't even know all the, the specific names of the drugs. That's
Alex's area, but they'll be injectables. Okay. And the reason we did injectables
is, you know, where generic drugs. overpriced dramatically, and patients get
ripped off is when there's not a lot of demand. And so if there's not a lot of
demand, like you saw with the pharmacy, bro, with derim, then you can just
jack up the price and nobody else is gonna enter that market.
[00:18:19] And so what we've tried to do with the injectables is look at a
variety, you know, a, a. Type of drug, um, injectables that don't have a ton of
demand individually, but in aggregate do so that we can be profitable enough to
support it. And there's, the existing pricing is so high that hospitals in particular
and doctors after them will buy from us.
[00:18:46] Halle Tecco: So while other manufacturers are moving overseas,
you are building in
[00:18:50] Mark Cuban: Texas? Yes. Yeah. Now that requires a lot of robotics
and a lot of technology, but that's exactly the way we're going to do it.
[00:18:56] Halle Tecco: Yeah, that's very cool. How is that different from
running the front end marketing site? It sounds like a completely different
[00:19:03] Mark Cuban: business.
[00:19:03] Yeah, of course. And that goes to another difference between us and
everybody else. They're in a race to get as many customers as they can. They
may be a public company and they want their stock price to go up. They may be
a private company with investors and they want their, their revenues and their
profits to go up.
[00:19:19] We're none of those things. I funded this whole thing and so, you
know, Wow. Our mission is to be the low cost provider, so we. You know, like
I said earlier, we're not doing all those bells and whistles. We're just focused on
this one thing and being great at
[00:19:35] Halle Tecco: it. And, and part of that is eventually being full stack,
perhaps?
[00:19:40] Um,
[00:19:41] Mark Cuban: probably not. Okay. Right. We'll probably outsource
as much as we can unless we feel we can do it cheaper in-house. Yeah. I think
we're better off going to see what else we can manufacture and let the
technology be outsourced while, you know, we can continue to expand
Manufac. So do
[00:19:57] Halle Tecco: you plan on adding life saving drugs like EpiPens or
insulin?
[00:20:01] So
[00:20:02] Mark Cuban: other than insulin, if it's generic, we're gonna do
everything we can to carry it. There's some generic insulins garland that we're
working things out on. Um, but the thing about insulin, because of the way it's
stored and everything, that just takes longer. So it's not something we can turn
around quickly.
[00:20:17] Now there's always legal, unfortunately, legal issues and all that
stuff, but whatever we're legally allowed to offer that is generic, then we're
gonna offer it. Trust me, we know the demand is there. We'll never say, Well,
the demand is there, but we don't want to do it. You know, it's always just gonna
be about access.
[00:20:35] And if we can, if we can find a source and it's cost effective,
meaning it's better than the other alternatives, um, then yeah, we'll sell it right at
cost plus 15%, no exceptions. Was
[00:20:47] Halle Tecco: there someone who faced this that
[00:20:49] Mark Cuban: really, No, it wasn't a personal experience thing. It
was more just the more I dove into healthcare, the more ridiculous it looked.
[00:20:56] Okay.
[00:20:56] Halle Tecco: But you, you listen to stories of patients, I assume,
while building this? Oh, of
[00:21:00] Mark Cuban: course. Yeah. And I mean, if, and just on Twitter
now, just the, the, the prescriptions we've already started to fill, you know, and
that number was just growing and growing quickly. Um, you're seeing people
post, you know, I was spending $245 a week, now I'm spending 30.
[00:21:14] I was spending $60, Now I'm spending $5. Wow. You know, that,
that's rewarding. I, I mean, you can't help but really, you know, appreciate
hearing
[00:21:23] Halle Tecco: that. Yeah. You wanna like print those out, put them
on the walls of the office? Yeah. I mean,
[00:21:27] Mark Cuban: or I'll just retweet them ,
[00:21:29] Halle Tecco: let, retweet them . Yeah. Yeah. So what's kind of the
end goal for you?
[00:21:34] Um, you know, You don't need to make a ton of money from this
business. Um, to six
[00:21:38] Mark Cuban: Cs. No, I just wanna keep on growing this bigger and
bigger
[00:21:41] Halle Tecco: and bigger. Yeah. Would, do you wanna continue to
maintain ownership? Is it something you'd wanna take public? What are kind of
some of your business
[00:21:47] Mark Cuban: goals? Yeah. I doubt we would take it public, but
Okay.
[00:21:49] You know, Um, all of our employees are owners and so, you know,
at some point, you know they're gonna want some financial reward, um, but
they know that the mission comes first. Yeah. Awesome.
[00:21:59] Halle Tecco: Well, is there anything else that you wanna share?
[00:22:01] Mark Cuban: You know, just to go to cost plus drugs.com, check it
out. Let us know if it works for you and what your experience is.
[00:22:08] You know. We, we just launched and you know, I'm sure we're
gonna make mistakes, but you know, our heart's in the right place and we wanna
learn and we want to get better. So, you know, try it. Tell your friends, tell your
family. If you're into support groups because you're unfortunately dealing with
the disease that requires a generic medication, please let all others in the same
boat know about cost plus drugs.com.
[00:22:32] You know, we're on a mission and Oh, the other thing I'll, I'll let
people know. Yeah. Right now we have about a hundred and a few drugs. We
plan on expanding that to several thousand over the next year or so, and. The
goal is to continually passing on any price reduction. So as our quantity of
purchases grow, we'll be able to get better pricing and everything is cost plus.
[00:22:54] So rather than keeping that margin, we'll pass it on as lower
[00:22:57] Halle Tecco: prices. Amazing. Is there a way to get a notification for
a specific drug that you're not selling now but may? We're
[00:23:03] Mark Cuban: working on that now. So if you go to Cost Plus and
just sign up. Yep. Then you'll get an ongoing email and that way you'll be ready
once all this is in
[00:23:11] Halle Tecco: place.
[00:23:12] Amazing. And the, and the prices will just get, keep getting better.
That's the hope because you guys have more leverage. That's great. Yeah.
[00:23:18] Mark Cuban: I mean, you know, you never, you know, a
manufacturer could raise their pricing on us for whatever reason their labor
costs go up. Sure. But, but the goal is really just to what, whatever our pricing
is, you know, and hopefully it goes down.
[00:23:31] Then we're gonna keep on passing that along. Very cool.
[00:23:35] Halle Tecco: Well, thank you for what you're doing and thank you
for being on the podcast
[00:23:38] Mark Cuban: today. Thanks for having me on. I really appreciate it.
[00:23:46] Thanks for listening to this episode of The Heart of Healthcare. If
you like this show, be sure to subscribe. Leave a review on Apple Podcasts.
Follow us on social, and tell all your friends to listen. The Heart of Healthcare is
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[00:24:05] Our executive producers are Matthew Zachary and Andrew
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