Employers have been hearing benefits consultants call for transparent, fair and affordable pharmacy benefits for years, and many have brushed the message aside. If the consultants haven’t moved you, maybe Mark Cuban will.
Why should employers listen to Mark Cuban?
Employers should listen because Cuban’s story is likely their own. Cuban, known for “Shark Tank” and his years as owner of the Dallas Mavericks, turned his attention to the rising and hidden cost of prescription drugs. He has said in interviews that the turning point came from his own company: as an employer, he realized his sickest employees were the ones funding the rebate checks his company received.
That is not a business quirk. It is a human problem. In many plans, an employee’s cost sharing is based on a drug’s list price, while the rebate that lowers the net price flows back to the PBM and the plan. The people who need the most medication pay the most, and the savings show up somewhere else.
What did Cuban do about it?
Cuban opened the Mark Cuban Cost Plus Drug Company’s online pharmacy in January 2022 with a plain message: drug pricing should be fair, visible and accessible, not hidden. Employers can see in that response what transparency looks like in practice.
Cuban’s approach is about business reform, but it is also about caring for people. His voice adds weight to what many consultants have been saying: the current system needs to change. For employers working through the decisions behind their health plan, his message is a reminder that every pharmacy contract has employees on the other end of it. If the logical case for transparency didn’t land, perhaps Cuban’s human one will.
How does Cost Plus compare with a PBM?
Cost Plus publishes every part of a drug’s price, while much of what a traditional PBM earns never shows up on the plan’s invoice. Employers can check the Cost Plus model on any drug the company sells. Each listing breaks the price into three parts:
| Part of the price | What it is |
|---|---|
| Manufacturer cost | What Cost Plus pays for the drug |
| Markup | 15% of the drug cost |
| Pharmacy labor fee | A set charge per prescription, currently $5.00 |
Shipping is added at checkout. The labor fee started at $3 and went to $5 in September 2023, which the company attributed to rising pharmacy labor costs.
Compare that with how a traditional PBM is often paid. The FTC’s July 2024 interim staff report found that the three largest PBMs processed nearly 80% of US prescriptions in 2023, and its January 2025 report found that pharmacies owned by those PBMs earned more than $7.3 billion above estimated acquisition cost on specialty generic drugs from 2017 to 2022. Spread pricing, rebate retention and pharmacy steering are hard to see from a plan sponsor’s chair. A published cost, markup and fee puts everything on the table, which is why Cuban’s model has drawn so much employer attention.
Cost Plus is not the right answer for every drug or every plan. The point for employers is the standard it sets: you should be able to see what a drug costs and what everyone in the chain keeps. We look at how that same concentration plays out across health care in the downside of vertical integration.
What should you ask your PBM?
Employers can put Cuban’s test to their own plan with a few direct questions:
- What does our plan pay for each drug, and what was the pharmacy paid? The difference is spread, and you should know whether your contract allows it.
- Where do our rebates come from, and who keeps them? Ask how rebates are defined in your contract and whether any are held by a group purchasing organization or other affiliate.
- How is employee cost sharing calculated? If it is based on list price, your sickest employees may be paying more than the drug actually costs the plan.
- Can we get drug-level claims data? Without it, you can’t check any of the other answers.
Ethos Benefits reviews PBM contracts and pharmacy spend through its pharmacy and PBM service. For more conversations about pharmacy benefits, listen to the Business of Benefits podcast.
Let’s make a commitment together.
The push for transparency in health benefits is more than a professional recommendation. It is a human necessity. Cuban, a businessman many admire for his directness, has made that need hard to ignore. When it comes to the health of your employees, transparency is the only policy that puts them first.