Mark Cuban's 5-Step Healthcare Fix Targets PBM 'Contractual Terrorism'

Mark Cuban told Texas House lawmakers on Sept. 1 that his pharmacy's cash price is often lower than what insured patients pay through their own plans. "They come to us because our cash price is often lower than what their insurance plan asks them to pay," Cuban said. "That tells you something is wrong." The billionaire cofounder of Cost Plus Drugs used the hearing to lay out a five-step plan for America's healthcare affordability crisis — a crisis that, according to West Health-Gallup, has left a record 51% of U.S. adults unable to reliably afford quality care.

The connective tissue across all five remedies: transparency.

What does Cuban's plan actually change?

1. Let insured patients pick the cheapest option — without penalty. If a prescription costs $500 through insurance but $100 through Cost Plus Drugs, patients should take the cheaper route and still have that spending count toward deductibles and out-of-pocket maximums. "Patients should be rewarded for saving themselves and their health plan money. They shouldn't be punished for it," Cuban said. "That's how you create something healthcare desperately needs: price competition."

2. Standardize contracts for drug middlemen. Cuban wants standardized contracts for pharmacy benefit managers and third-party administrators. Three PBMs — CVS Caremark, Cigna's Express Scripts, and UnitedHealth's OptumRx — handle roughly 80% of U.S. drug claims. Their contracts can run hundreds of pages, making harmful terms easy to bury. "I call it contractual terrorism," Cuban said. He has already drafted a model PBM contract that states, cities, counties, and school districts could adopt. "Just stop making every government entity negotiate these contracts from scratch," he said. "It's a losing game for everybody."

3. Make pricing public wherever taxpayers foot the bill. Any taxpayer-funded program, including Medicare and Medicaid, should disclose pricing data such as rebates, fees, guarantees, and affiliate compensation. Without that "price discovery," Cuban argued, a market can't function efficiently when one party holds all the information.

4. Eliminate gag clauses. These provisions keep employers and plan sponsors from openly discussing contract terms, which Cuban said blocks them from comparing fees and negotiating better deals.

5. Give enforcement real teeth. Regulators could go easy on a first significant violation, Cuban said, but repeat offenders should face much steeper penalties. Under the current system, he said, "some of these companies can make billions, get caught, pay a fine," and "write it off more easily than I wrote off my NBA fines." He added: "That's not deterrence. That's a cost of doing business for them."

The through-line: three companies controlling 80% of drug claims, with contracts nobody can read, is where Cuban wants the state to push first.

Who are Cuban's unlikely allies?

Cuban's drug-pricing crusade has produced strange political bedfellows. In May, TrumpRx — the White House-backed discount drug site — added more than 600 generic medications through Cost Plus Drugs, alongside Amazon Pharmacy and GoodRx. That deal put Cuban on the same side as President Donald Trump, who called him "a loser" during the 2024 campaign.

In March, Cuban backed the Break Up Big Medicine Act, sponsored by another odd couple: Sens. Josh Hawley (R-Mo.) and Elizabeth Warren (D-Mass.). The bill would bar a single company from owning both an insurer or PBM and medical providers. It has been referred to the Senate Judiciary Committee and hasn't advanced. Cuban has kept pressing the case regardless, recently arguing that rising healthcare costs — not AI — are the real threat to American jobs.

The Texas hearing, the model contract, and the stalled Senate bill all point in one direction: Cuban is betting states, not Washington, move first on PBM transparency.