Large companies can save millions of dollars by addressing one common misconception about health insurance plans, according to billionaire entrepreneur Mark Cuban.
Mr. Cuban, who entered the pharmaceutical industry as a disruptor in January 2022 with his company, Mark Cuban Cost Plus Drugs, shared his thoughts on pharmacy benefit managers with Becker's on Sept. 25.
Editor's note: Responses have been lightly edited for clarity and length.
Question: We've talked before about pharmacy benefit managers and why Cost Plus Drugs partners with pass-through PBMs. How do you see the FTC's recent lawsuit against PBMs influencing the industry?
Mark Cuban: I think it's a positive step towards transparency. The only real advantage the big PBMs have beyond their size is the fact that the industry is opaque. This is a positive first step to reducing that problem.
Q: What implications will this have for Cost Plus Drugs and your mission to enhance transparency and affordability in prescription drug pricing?
MC: None really. Our biggest issue is the big PBMs doing what they can to prevent brands from selling to us. This doesn't change that.
Q: What misconceptions do employers typically have about the role of PBMs in managing prescription drug costs, and how do these misunderstandings affect their overall healthcare strategies?
MC: That they save them money and add value. They don't do either. What really happens is that companies get addicted to the rebates and can't audit their payments versus their contracts. And when they try, the big PBMs don't provide the needed claims data or require them to use a company affiliated with the PBM to do the audit.
It's insane that for most companies they don't own or have immediate access to 100% of their claims data … have control of their formularies and are not allowed to talk about their contracts with anyone, nor can they talk directly to manufacturers to put together wellness programs.
Pass-through PBMs like AffirmedRx, SmithRx, Rightway and many more solve this problem and save companies money.
For some bigger companies, there are millions, if [not] tens of millions of dollars, available to them if they would switch PBMs, add biosimilars like Yusimry and stop using their big PBM's captive pharmacy.
Q: What strategies should employers consider to effectively improve employee health outcomes?
MC: Leave the big three PBMs and work with a pass-through PBM. It's that simple.