Mark Cuban on High Drug Prices, Taxing Billionaires, and 2028
with Mark Cuban
21 Aug 20265 min read1h 10m
TL;DR
Mark Cuban argues that PBMs — pharmacy benefit managers owned by healthcare conglomerates like UnitedHealth, CVS, and Cigna — are the primary driver of high drug costs, using secret formulary control to block competitors like Cost Plus Drugs from accessing branded medications. He says CEOs of self-insured companies, who cover 67% of employer-insured workers, hold the real power to disrupt the system by running their healthcare contracts through AI tools like Claude to expose hidden fees. Biosimilars for drugs like Humira (dropping from $8,000/month to ~$450) and Stelara drove the biggest drug price drop in 60 years — not government policy.
Key Moments
Mark Cuban
“For Humira, it went from $8,000 a month to like $400 a month, $450 a month on cost plus.”
Cuban explaining how biosimilars — generics for injectable drugs — drove the biggest drug price drop in over 60 years
“The answer is always identical because the PBMs have told us if we deal with cost plusddrugs.com we are going to they will diminish us on their formularies and as I said it could cost tens of millions hundreds of millions billions of dollars across their entire drug portfolio.”
Cuban explaining why brand-name drug manufacturers refuse to sell through Cost Plus Drugs despite having millions of customers
“When you listen to the quarterly earlings conference calls or run them through your favorite LLM, right, and you just say, 'Did they say anything about reducing costs for patients?' The answer is never yes.”
Cuban responding to his own X post arguing that shareholders in big insurance funds are part of the healthcare cost problem
“chips are like, you know, the Nvidia chips, AMD chips, maybe TPUs from Google and some others... They're like apartments, right? You can rent them and when they're brand new, they're worth the most.”
Cuban explaining his prediction that AI chips will become the next investable asset class, analogous to crypto but with real underlying utility
Mark Cuban is a serial entrepreneur and investor best known as the former owner of the NBA's Dallas Mavericks. He co-founded Cost Plus Drugs (costplusdrugs.com), a pharmacy that sells medications at cost plus 15% markup with full price transparency. Cuban is an outspoken critic of the pharmaceutical middleman system, particularly PBMs and large healthcare conglomerates, and regularly advocates for structural reform in American healthcare.
Takeaways
1
Run your healthcare contracts through Claude — today Cuban's most actionable claim: any company with 1,000+ employees can run their PBM and TPA contracts through Claude or ChatGPT with the prompt 'how am I getting ripped off?' PBMs bury tricks in definition mismatches across 50-200 page contracts — AI catches them instantly. Cuban says multiple large companies have already switched to pass-through PBMs like Rightway and Smith RX after doing this.
2
CEOs of self-insured companies hold the real healthcare lever Self-insured companies cover 67% of employer-insured workers in the US, meaning corporate CEOs — not Congress — control the single biggest lever for disrupting PBM dominance. Cuban argues that tech companies in particular are leaving tens of millions in healthcare savings on the table because HR teams are overwhelmed handling claim denials and have no bandwidth to renegotiate contracts.
3
PBMs weaponize formularies to block transparent competitors Cost Plus Drugs can get nearly every generic but is effectively locked out of branded drugs because PBMs threaten manufacturers with formulary removal — worth hundreds of millions across their entire portfolio — if they sell through Cost Plus. This is why transparency hasn't spread to specialty drugs despite Cost Plus proving the model works for generics.
4
Biosimilars — not policy — drove historic drug price drops The biggest year-over-year drug price drop in 60 years was primarily caused by biosimilars entering the market for drugs like Humira (from $8,000/month to ~$450) and Stelara (from $128,000/year to $365 on Cost Plus). Medicare negotiation under the IRA helped at the margins, but biosimilar competition was the structural driver. The policy story is real but overstated.
5
AI chips as tokenized assets: Cuban's next crypto narrative Cuban sold most of his Bitcoin, arguing it has 'lost the plot' as a hedge against instability because prices haven't moved despite dollar weakness and geopolitical turmoil. His replacement thesis: Nvidia/AMD AI chips tokenized as real-world assets, like oil barrels — you buy the right to compute revenue from a specific chip. Still early, but he says the narrative and crypto-community appeal are already there.
6
Bipartisan 'break up big medicine' bill has zero co-sponsors The Josh Hawley / Elizabeth Warren bill to break up large healthcare conglomerates — which would directly address PBM consolidation — attracted not a single Senate co-sponsor and was never introduced in the House. Cuban says he spoke to senators directly; their private answer was consistent: 'we want their money' and 'we have midterms coming up.'