Past AVBCC Educational Summits

Mark Cuban has made a name for himself as a disruptor across various industries—systems integration, streaming, even the NBA, as the former owner of the Dallas Mavericks—and became a billionaire in the process. He’s taking on the legacy drug channel with his latest venture, costplusdrugs.com, which touts transparent pricing and a limited markup on medications.

Motivated by the high cost of generic drugs for his patients, Alex Oshmyansky, MD, PhD, pitched the concept for Cost Plus Drugs to Cuban, who became an investor and cofounder.

After Dr. Oshmyansky’s initial email, Cuban began doing his own background research and was quickly struck by what he described as “an incredibly opaque industry.”

“The entrepreneur in me was like, ding-ding-ding, there’s an opportunity here,” Cuban said. “If nobody wants to show their prices, costs, or markups, guess what we’re going to do?”

The costplusdrugs.com website launched in January 2022 with 111 generic medications, according to Cuban. Traffic to the site increased dramatically over a matter of days, as it became known that Cuban was involved and that many of the medication prices were substantially lower than pharmacy benefit managers (PBMs) and health insurers were achieving in the marketplace. He said the company is also now contracting directly with community pharmacies, with more than 9,000 across the United States enrolled.

By way of example of the savings that Cost Plus Drugs is providing in the market, session moderator Antonio Ciaccia of 3 Axis Advisors and 46brooklyn Research highlighted how his firm’s recent analyses of pharmacy claims data from employers revealed Cuban’s savings of more than 99% on PBM charges for oncology medicines like imatinib and abiraterone. These findings echoed similar research works focused on Cost Plus Drugs savings on Medicare prices, as well as recent investigations into PBM pricing from the Federal Trade Commission.

With the company’s new prominence, Cuban has become an advocate for overhauling the U.S. healthcare system. The day before this AVBCC discussion, he testified before the U.S. Senate Aging Committee about healthcare affordability and the need for modernization, focusing on price transparency, and competition. A week later, at a separate hearing, he endorsed the elimination of pharmacy benefit managers (PBMs) and expressed support for the TrumpRx program, which intends to eliminate third-party markups for medications.

“The biggest lie in all of healthcare is that PBMs negotiate lower prices. They don’t. What they do is sell access to their formularies” Cuban said when asked what he said during his Senate Aging Committee testimony. “And I think that resonated.”

Cuban believes PBMs are the main contributor to the inflated pricing of medications in the U.S.

“This is the only industry where wholesalers pay retail price,” he said, adding, “It makes no sense. And that’s where everything starts to fall apart. Then the question becomes, why has it stayed this way instead of manufacturers moving to a net cost? … Well, it’s because you have these other players over here owned by the biggest insurance companies called PBMs.”

The PBMs cannot force drug manufacturers to set the higher price, Cuban said, but they can, and do, incentivize it—while making more and more profits underneath ever-increasing list prices for medicines.

But the biggest loser in this process is not the manufacturers, nor the businesses, large and small, for whom health insurance premiums have increased by more than 40 percent over the last two years, according to Cynthia Fisher, Founder and Chairman of the nonprofit PatientRightsAdvocate.org, who joined the discussion. With employee premiums and deductibles also increasing at an unprecedented rate, Cuban and Fisher agreed the patient is feeling the brunt of this dysfunctional system. Where everything should be designed with the aim of aiding the patient, Fisher says, it’s instead set up to wring as much money from the patient’s care as possible.

Both Cuban and Fisher advocated for a new paradigm where the intermediaries are eradicated and patients pay pharmacies, physicians, and medical centers directly for their care, and the prices are agreed upon and available to everyone beforehand. A change such as this can start with employers, they said. Cuban predicted a “groundswell” of support for direct contacts and financing that could set it in motion.

President Donald Trump has already displayed the ability to affect many of the world’s largest economies through the threat of implementing, or increasing, trade tariffs. Can he influence drug pricing and health policy to a similar degree? In this one-on-one discussion, Joseph Grogan, JD, the director of the United States Domestic Policy Council and assistant to President Trump during his first term, provides a unique perspective on the President’s preparedness and desire to pursue such reforms.

Only weeks earlier, President Trump announced a deal with Pfizer to sell its drugs direct to consumers at discounted prices through a website operated by the federal government called TrumpRx.gov. The new site is part of a broader initiative sometimes called most-favored-nation pricing the administration says is aimed at bringing drug prices paid by Americans more in line with other developed—namely, European—countries.

The original iteration of most-favored-nation pricing, Grogan said, dates back to President Trump’s first term. It was in development for three years before it was ultimately repealed by the Biden administration. This time around, President Trump seems determined to change the paradigm, Grogan said.
“I think this President is totally prepared to put pharmaceutical executives on U.S. government planes with U.S. trade representatives and go to any European regulator and say, ‘You should pay more,’ just as he played hardball with NATO,” he said.

The question then becomes, will they?

“We’re already seeing companies say they’re not launching in this market unless they get more money, AstraZeneca saying they’re going to retreat from their commitment to the United Kingdom if they don’t get more money,” Grogan said. “So you’re finally starting to hear it.”

He added: “I will say this: I think it is a little bit disappointing, from my perspective as a veteran of the industry, that the companies were not saying this publicly in the past, that they didn’t rise to the challenge. Because, frankly, we do shoulder a disproportionate amount of the research and the pharmaceutical engine for the rest of the world, and it isn’t fair to do that to American taxpayers and consumers.”

In July, President Trump sent letters to the leaders of 17 major pharmaceutical companies with a list of demands, including lowering prices in Medicaid and selling drugs directly to consumers at lower prices. Grogan speculated that the administration may be willing to negotiate with each of these companies, but, ultimately, “the letter is really the path they want to see companies going.”

Moderator Jayson Slotnik, JD, MPH, a partner at Health Policy Strategies, asked if the launch of TrumpRx.gov—which is expected to occur sometime in 2026—could lessen the administration’s appetite for further policy reform, specifically, strengthening the oversight of pharmacy benefit managers (PBMs). Grogan said that while the administration is “interested in transparency,” any regulation involving PBMs could threaten Medicare Part D, the prescription drug benefit for Medicare, which, he said, is on the verge of collapse as a result of the Inflation Reduction Act (IRA).

Signed into law by President Biden in August 2022, the IRA, notably, introduced a $2,000 out-of-pocket spending cap and set in law a maximum monthly price for insulin of $35. It also requires drug manufacturers to pay rebates if their drug prices increase faster than inflation. And cost-sharing in the final phase of the Part D benefit, the catastrophic coverage phase, was eliminated.

But Medicare Part D is now “about as unstable as you can have, and we are headed toward some type of collapse of the program,” Grogan said.
“So, I could see another agreement announcement with payers similar to the one they did on [Medicare Advantage] prior authorization around some commitments on PBMs,” he added. Congress is once again considering PBM legislation, with Sens. Crapo and Wyden set to introduce a package of reforms which did not pass at the end of the last Congress. It is unclear whether or not the package can pass in this new effort in view of competing priorities in Congress.

Sunil Verma, MD, joined AstraZeneca so that he could have a greater impact on improving cancer outcomes than he did as a medical oncologist. Today, he’s a senior vice president with the company and the global head of its oncology franchise. In this one-on-one discussion with Suneet Varma, MD, the former global president of Pfizer Oncology, Verma explains how AstraZeneca cultivates innovation and shares his vision for reshaping clinical trials in the United States.
AstraZeneca operates in more than 80 countries and runs clinical trials in more than half of them, according to Verma. Its ability to enroll patients in many of these countries, including Spain, Italy, Germany, South Korea, and China, is relatively easier than it is in the U.S., he said.

“Clinicians, health systems, organizations, ethics boards, and regulatory agencies are all committed to bringing clinical trials to those countries,” Verma said. As a result, “We can open a clinical trial in a [cancer] center in South Korea, enroll patients, and hit our targets before we can even open a center in the U.S.”
He estimates that five to 15 percent of patients currently enrolled in AstraZeneca-run clinical trials are in the U.S. Whereas China, for example, is investing heavily in its cancer care infrastructure, building numerous new centers and staffing them with investigators who are enrolling patients at an exceptional rate, according to Verma.

Simply put, Verma believes there could be serious implications if participation in the US does not increase significantly within the next five years.
Citing a study which found that health centers that participate in clinical trials have better outcomes than those that do not, Verma said AstraZeneca is planning to move away from the “ivory tower selection process”—referring to the fact that academic hospitals comprise the vast majority of clinical trial participation in the U.S.—by making trials more accessible to community health systems.

This, he believes, could have a couple additional benefits. First, oncologists in community hospitals and centers would be more likely to be familiar with a therapy once approved by gaining hands-on experience with it during a clinical trial. Second, the patients recruited for clinical trials would likely be more diverse than trial participants currently are.

“Trial representation, to us, is no longer just about race, ethnicity, or gender,” Verma said. “It’s really about zip code, making sure that our clinical trials are being conducted in close proximity to where patients live.”

He said AstraZeneca has already begun collaborating with the American Cancer Society to see if patient navigation could help improve access to clinical trials for patients and communities who have been historically underrepresented in them.

The AstraZeneca-run trials in China, Verma conceded, are part of a much larger innovation boom in the country at the moment. He estimated that a significant amount of the new cancer therapies that entered the market last year originated in China. His company, he said, maintains a “very active unit” in China—along with others in the U.S. and Europe—that explores potential partnerships of all sorts.

Verma said that investing across “key tumor areas” has also been a critical piece of the company’s strategy for its oncology franchise. “That allows us to make sure that we have foundational therapies across all stages of cancer in key tumor areas,” he said.

“What happens when we have that is we start to have a very different dialogue with our health system partners,” he added. “We also have a very different discussion with future pharmaceutical partners because we have a foundational backbone across all stages. And that allows us to have combination opportunities, diagnostic opportunities, and biomarker-stratified clinical trials.”