Mark Cuban Says 'This Is Single-Payer': How His Healthcare Model Could Transform The U.S. Healthcare System
Mark Cuban Says 'This Is Single-Payer': How His Healthcare Model Could Transform The U.S. Healthcare System
Kaili Killpack
Tue, December 31, 2024 at 10:30 AM EST 4 min read
https://finance.yahoo.com/news/mark-cuban-says-single-payer-153015416.html
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Billionaire entrepreneur Mark Cuban has been vocal about reshaping the U.S. health care system for years. During recent appearances on podcasts Fishbowl with Jules Terpak and Ground Truths with Dr. Eric Topol, Cuban discussed how his plans aim to address system inefficiencies and reduce consumer costs. His ideas could pave the way for significant changes in how Americans access and pay for health care.
A Closer Look at Cost Plus Drugs
Cuban designed his pharmaceutical company, Cost Plus Drugs, to provide medications at drastically lower prices by eliminating traditional middlemen. He explained on Ground Truths that many pharmacy benefit managers (PBMs), such as CVS Caremark, Optum and Express Scripts, add layers of complexity and hidden costs. Cuban's company bypasses these PBMs, offering transparent pricing and preventing unnecessary markups.
"The smartest thing we did was publish our entire price list because that allowed any company, any sponsor, CMS, researchers to compare our prices to what others were already paying," Cuban said. He noted that the pharmaceutical industry has been the easiest to disrupt; "all it took was transparency and not jacking up margins to market."
Direct Contracts with Hospitals
Another innovative approach Cuban takes to improving health care, particularly for his employees, is direct contracting with hospitals and clinics. On Fishbowl, he explained how his companies negotiate agreements that eliminate deductibles, pre-authorizations and denials. Instead, they pay providers up front, ensuring no financial risk for hospitals and reducing the administrative burden. This model incentivizes efficiency while maintaining quality care.
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https://www.ftc.gov/system/files/ftc_gov/pdf/pharmacy-benefit-managers-staff-report.pdf
I. EXECUTIVE SUMMARY
This Interim Report is part of an ongoing study by the Federal Trade Commission (“FTC” or the
“Commission”) of pharmacy benefit managers (“PBMs”) and their impact on access to and
affordability of medicines. It describes how, amidst increasing vertical integration and
concentration, these powerful middlemen may be profiting by inflating drug costs and squeezing
Main Street pharmacies.
PBMs are at the center of the complex pharmaceutical distribution chain that delivers a wide
variety of medicines from manufacturers to patients. PBMs serve as middlemen, negotiating the
terms and conditions for access to prescription drugs for hundreds of millions of Americans. Due
to decades of mergers and acquisitions, the three largest PBMs now manage nearly 80 percent of
all prescriptions filled in the United States. They are also vertically integrated, serving as health
plans and pharmacists, and playing other roles in the drug supply chain as well. As a result, they
wield enormous power and influence over patients’ access to drugs and the prices they pay. This
can have dire consequences for Americans, with nearly three in ten surveyed Americans reporting
rationing or even skipping doses of their prescribed medicines due to high costs.
PBMs also exert substantial influence over independent pharmacies, who struggle to navigate
contractual terms imposed by PBMs that they find confusing, unfair, arbitrary, and harmful to their
businesses. Between 2013 and 2022, about ten percent of independent retail pharmacies in rural
America closed. Closures of local pharmacies affect not only small business owners and their
employees, but also their patients. In some rural and medically underserved areas, local community
pharmacies are the main healthcare option for Americans, who depend on them to get a flu shot,
an EpiPen, or other lifesaving medicines.
PBMs oversee critical decisions about access to and affordability of medications without
transparency or accountability to the public. Indeed, PBM business practices and their effects
remain extraordinarily opaque. Accordingly, in 2022, the FTC issued special orders pursuant to
Section 6(b) of the Federal Trade Commission Act (the “6(b) Orders” or “Orders” ) to the six largest
PBMs—Caremark Rx, LLC; Express Scripts, Inc.; OptumRx, Inc.; Humana Pharmacy Solutions,
Inc.; Prime Therapeutics LLC; and MedImpact Healthcare Systems, Inc. (the “PBM respondents”
or “respondents”). The Orders requested data and documents regarding these six large PBMs’
businesses and business practices. In May and June 2023, the FTC issued supplemental Orders to
produce data and documents to three additional PBM-affiliated entities.
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Thank you sir!!
