Mark Cuban Tells Us How He Can Fix America’s Shitty Health Care
The entrepreneur wants to do what many in his position have tried and failed to accomplish.
MOST PEOPLE KNOW Mark Cuban as a celebrity entrepreneur and investor, the guy you have seen on Shark Tank or courtside at Dallas Maverick games.1
Those of us who follow health policy know him as something else. He’s the business mogul who said he knew how to sell prescription drugs at a big discount, and proceeded to do just that.
Now Cuban says he has more ideas—not just on how to fix prescription drug pricing, but on how to reform the U.S. health care system more broadly. Earlier this month, I got to hear some of them when he sat down for an interview via Zoom.
As I told him at the top, I’m generally skeptical of people in his position. There’s this long, well-known history of business figures vowing to fix health care—because, supposedly, the insights they have from finance, tech, or retail will allow them to make our famously dysfunctional system more functional. That’s what all the breathless headlines said in 2018, for example, when Jeff Bezos, Warren Buffett, and Jamie Dimon announced their joint venture to revolutionize health care.
The venture went bust three years later, which is pretty much the way all of these projects have gone. Health care, it turns out, really is different from any other business. Plus it’s harder and maybe less fun than picking investments—or, if you’re Bezos, building rockets and burning down the Washington Post editorial page.2
But Cuban stuck with health care, a subject he says first piqued his interest following the 2015 controversy over a massive (500 percent) price increase for drug to treat a common parasitic infection. A few years later, Cuban got a cold pitch from a doctor interested in selling generic drugs for rare conditions, where shortages were common. Cuban was hooked; he invested and turned the company into Cost Plus Drugs, which today sells drugs directly to consumers online and at deeply discounted prices.
Cost Plus Drugs gets these bargain rates by cutting out industry middlemen called “pharmacy benefit managers.” PBMs, which have been around since the 1960s, are supposed to negotiate lower prices with manufacturers on behalf of insurers and employers. And sometimes they deliver real savings. But as scholars, analysts, and journalists have shown, PBMs frequently keep prices artificially high—thanks, in part, to the confidential, convoluted payment arrangements they make with manufacturers.
Cost Plus Drugs calculates what it believes is the actual manufacturing cost for a drug, adds on a 15 percent markup plus fixed fees for distribution, and sells it at that price. It makes the full calculations available to consumers on the website, and shows how much more the drug would cost elsewhere.
Cuban wasn’t the first person to decry the mysterious, potentially pernicious role of PBMs in sustaining high drug prices. And his company’s reach is limited, both in the types of drugs it covers (mostly generics, at least for now) and the people whom it benefits directly (those whose drug needs line up with what the website has available). But as Rachel Sachs, a Washington University law professor and expert on drug pricing told me, addressing “even one of the pathologies in our health care system” is a big deal.3
Now it appears Cuban would like to do more. He’s constantly engaging in debates about health policy, whether on social media or at live events. He’s dabbled in politics too—most recently, during the 2024 presidential campaign, when he endorsed Kamala Harris and vouched for some of her health care proposals.
Those appearances are one reason Cuban gets mentioned as a presidential candidate in 2028. A more likely role for him (I am guessing) would be as somebody offering input on health policy. And while he doesn’t seem to have strong partisan leanings, Democrats in particular have reason to hear him out.
Here’s why. For the last fifteen years, party leaders have been understandably preoccupied with defending the Affordable Care Act. And they can’t stop now, given that Donald Trump and the Republicans are still trying to roll back the law.
But “Obamacare” was never meant to be an end point. It was supposed to be a stepping stone on the road to a system that made health care accessible to all, while getting costs under control. Sometime soon, Democrats will have to talk more concretely about what comes next, whether it’s continuing to build on or around current arrangements, or trying something more sweeping.
Cuban shared some of his thoughts about that in our conversation. Some of the things he said made a lot of sense to me, some . . . not so much. Some simply surprised me.
Among other things, Cuban was a lot more critical of Sen. Bernie Sanders than Sen. Rick Scott even though the Vermont independent has spent a political lifetime fighting to bring down drug costs and the Florida Republican famously made his fortune by leading a company later caught in what was—at the time—the largest Medicare fraud in American history. Cuban also brushed off past criticisms of Trump, telling me he didn’t remember saying in 2024 that Trump has “fascist tendencies.”
But Cuban said he had reasons to steer clear of the kind of political language he used before: He feels like he can make a difference on health care by working with both parties, including the Trump administration as it constructs its own direct-to-consumer drug website (TrumpRx) that could end up directing people to Cost Plus Drugs.
Cuban’s scattered views defy easy categorization. One minute he sounds like a conservative talking up the power of shopping, the next he’s defending universal systems abroad. During our interview Cuban said he believes the government should be in the business of making sure everybody can get health care. In an ideal system, he told me, “everybody gets the health care that they need at a price they can afford. . . . you’d pay what you could afford, and the government would pay the rest.”
If he’s serious about that commitment—and if he’s willing to share his deep, specialized knowledge of how prescription-drug pricing really works—then his voice could be an interesting and important one for anybody interested in making health care available to all.
You can decide for yourself by watching a lightly edited video of our interview on Substack or on YouTube—or by reading some excerpts of our conversation below.
Mark Cuban on why he got into business selling drugs at a fixed markup, when he could make more money by selling at higher prices:
“Because I’m rich as fuck and I didn’t care about the money. . . . My next dollar is not going to change my life.”
On the problem of with PBMs:
“It’s like—what’s the movie, The Usual Suspects, where they said the greatest lie the devil ever told was telling you they don’t exist? The greatest lie ever told by PBMs is that they get the best price for you.”
On what an ideal health care system would look like:
“It would be completely transparent—you’d pay what you could afford, and the government would pay the rest. Every employer would pay some set amount that would end up being less than what they’re paying today. So it might be 10 percent of everybody’s income. We wouldn’t change Medicare, we wouldn’t change Medicaid. We’d ditch the ACA, we’d ditch employer-based healthcare, but that employer would still pay their percentage.”
On the Democrats generally:
“They’re not offering any solutions and they’re certainly not saying ‘Break up the big insurance companies, break up the big hospital networks.’ At least if they said that, it would show that they understood what the hell was going on.”
On the Republicans (and Democrats) who do take health care seriously:
“Ron Johnson, Rick Scott want to do something. Elizabeth Warren wants to do something. There are people on both sides that want to do something that have talked about specifics, but it’s not hard to come up with these plans. They just do it half-assed.”
On why he’s not engaging in bigger political fights while focusing on health care:
“You can’t win all battles, right? And the more I talk about the political side of it, the less impact I’m able to have on health care. And the thing about health care, it impacts everybody. Nobody dies healthy. And nobody likes the economic side of health care like we have it today. And I truly believe that I can have an impact there. . . . I’d rather at the end of the day be called the guy who didn’t speak up on A, B, and C, but changed health care in the United States so that X number of people didn’t die because they could afford their medication.”
Cuban became a courtside regular after purchasing the Mavericks in 2000. He sold his majority stake in 2023 but retains a minority stake and still shows up at games.
Full disclosure: Bezos’s trashing of the Washington Post editorial page has worked out well for The Bulwark and its readers.
Another top expert, KFF Executive Vice President Larry Levitt, put it to me this way: “Cuban’s efforts have brought some welcome sunlight into the black box of drug pricing in the United States. Cuban has been particularly effective at delivering transparency and lower prices for cash paying patients needing generic drugs. He’s been less successful at lowering prices for brand name drugs, and in breaking into the market for people who fill prescriptions using their insurance.”
As a physician and on Medicare, we have an efficient system that works, Medicare. Eliminate insurance companies, which are responsible for approximately 35% overhead, on the insurance and provider side. Eliminate for profit hospitals, lousy healthcare for high costs. As far as drugs, I buy my Crestor from overseas. Most drugs are made in China or India. We just get ripped off. As far as Democrats talking about insurance companies, Republicans will just scream socialism.
With Medicare, I just go to a physician and get care without pre authorization nonsense. As far as talking about Scott or Johnson concerned about healthcare, give me a break. They voted for RFK, Jr.
There are two goals. First, the pool of insured people needs to be as large as possible to spread risks. That is, everyone needs to be included from birth to death. Secondly, the consumer needs to tell the supplier what it will pay and what will be covered. In other words, Medicare for all is the solution to the problem. I know that people will complain that it is socialized medicine. That is exactly what Medicare and the VA health system are now. The problem is that the risk pools are not sufficiently diverse with Medicare and the VA.