February 27, 2026 • 41 mins
Entrepreneur Mark Cuban talks to Margaret Hoover about what is wrong with the healthcare system in America and how he hopes to fix it.
Since selling his majority stake in the Dallas Mavericks and quitting ABC’s “Shark Tank,” Cuban has focused his energy on disrupting the healthcare industry. He explains how his company, Cost Plus Drugs, works and why he is taking on pharmacy benefit managers–the insurance industry middlemen he blames for rising drug costs.
Cuban addresses broader questions about the industry, telling Margaret why he supports bipartisan legislation to break up big healthcare companies, why he thinks TrumpRx is a good program, and why he doubts universal healthcare is feasible in America today.
Cuban, who endorsed Kamala Harris in 2024, also reflects on the Democratic Party’s communication problems and comments on whether he would consider running for president himself in 2028.
Support for Firing Line with Margaret Hoover is provided by Robert Granieri, Vanessa and Henry Cornell, The Fairweather Foundation, The Tepper Foundation, Peter and Mary Kalikow, The Beth and Ravenel Curry Foundation, Pritzker Military Foundation, Cliff and Laurel Asness, Katharine J. Rayner, Charles R. Schwab, Lindsay and George Billingsley, The Meadowlark Foundation, Jared Stone, and Al and Kathy Hubbard.
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Episode Transcript
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(00:01):
There's an information asymmetry, literally, Margaret.
I'll sit and talk to CE OS of companies and even though it's
their largest expense after payroll, they have no idea how
their benefits work. They have no idea what they're
paying for anything. And when I suggest that they go
and have it all audited by a third party, the insurance
companies will not allow it. That's billionaire entrepreneur
(00:23):
Mark Cuban explaining what he believes is wrong with
healthcare in America. I'm Margaret Hoover.
This is the FIRING Line podcast.Mark Cuban found success as an
Internet pioneer, as an outspoken owner of the Dallas
Mavericks and as a star of ABC'sShark Tank.
(00:44):
I'll give you the $400,000, but I want 16%.
But now he is dedicating his focus and his money to
disrupting the healthcare industry.
There's nothing that gets me more excited in the morning
after my family than coming in and wanting to F up the entire
healthcare industry. In 2022, Cuban launched Cost
Plus Drugs to offer prescriptionmedications at low prices and to
(01:07):
undercut the insurance industry middleman that he blames for
skyrocketing costs. There is no reason why it needs
to be this way. And so can we get it done?
Yes. But in the meantime, are we
willing to let people die? But what does Mark Cuban make of
President Trump's efforts to shake up the system?
So I'm all for Trump RX whatevergets people lower priced
(01:29):
medications. Yes, sign me up.
Mark Cuban, welcome back to FIRING LINE.
Thank you for having me. Over the last 40 years in the
United States, drug costs have increased 3 times the rate of
inflation. In 2022, US drug prices were
nearly three times higher than comparable developed countries.
(01:51):
And in President Trump's State of the Union address this week,
Trump called healthcare costs, quote one of the biggest RIP
offs of our time. Why are Americans getting ripped
off? Well, the one thing from a
business perspective that differentiates the United States
versus all the other developed nations when it comes to drugs,
(02:12):
we have these things called pharmacy benefit managers.
They don't, Period. End of story.
PBMS, pharmacy benefit managers who are purportedly middle men
between your insurance company and your pharmacy.
Right In 2018, you got this e-mail from a radiologist
complaining about drug prices. Four years later you start your
own company cost plus drugs and and it and it is intended to
(02:35):
offer fair price drugs, generic drugs to the public directly
without having to go through a middle man.
You are now today selling thousands of drugs to millions
of customers and you have your own factory manufacturing
medicines. So in layman's terms, what is
the problem that your company issolving?
(02:56):
We're transparent. When you go to
costplusdrugs.com, you put in the name of the medication.
If it's one of the thousands we carry comes up and we show you
our actual cost, our little actual cost, we show you our
markup, which is only 15%. And if it's mail order, it's $5
to ship it to you, that's it. And so any medication that you
make it prescribed, you can check our price 1st.
(03:18):
And here we are four years laterfrom our launch.
We're still the only pharmacy that publishes a price list and
we update our update our price list every day.
Let's take a concrete example, Imatinib.
Imatinib is a drug that treats chronic myeloid leukemia, right?
OK. Today on Goodrx, the pharmacy
prices it for 30 pills, 400 milligram tablets.
(03:39):
The range is from $94.00 to $4000.
On your site cost plus drugs it's $34.50.
Why? Because good RX works inside the
system and they work with PBM, they work with the insurance
companies, right by going to cost plus Drugs.com, we charge
the same price to everybody. When our costs go down, we pass
(04:02):
through the the lower price. So first.
I don't go to cost plus blood drugs.
I don't actually know how much my drugs cost.
Pretty much, yeah. And so not only do you not know
what your drugs are going to cost, your employer doesn't know
what they're paying for the drugs that you are using.
So that's Part 1 transparency. Part 2 is fairness and pricing.
(04:22):
We only mark it up 15%. And because we only mark it up
15%, people trust us. You know, there's there's
something I heard that really stayed with me.
They said there's a there's a formula for trust.
It says trust equals transparency divided by
self-interest. The more transparent you are,
the higher the numerator. The less self-interest you have,
(04:44):
the bigger the total number. By only marking up 15%.
People trust us and that's why they come to us.
We spend no money on marketing. 0 Not a penny.
It sounds like what you're saying is you've identified that
the problem is that an average consumer of drugs of
pharmaceuticals has no idea whatthey cost because they have
employer provided healthcare or they have some other kind of
(05:05):
healthcare benefit that just gives them their drugs for a
certain price, but they don't know the actual rate.
So it's a is what you're trying to solve a market problem?
Yes, it's it's the way the industry is structured.
Why have drugs gotten so expensive over the last 40
years? The way the industry is
structured is you have these enormous insurance companies
(05:26):
that in turn have, you know, thebiggest insurance company in the
country has 2600 subsidiaries through and they have $160
billion in intercompany transfers and that out there so
big and they're you know, they own doctors providers, park
pharmacy benefit managers, some cases pharmacies, specialty
(05:47):
pharmacies. They are so vertically
integrated. They literally control and set
the pricing of all the economicsis there in all of healthcare,
not just. Monopoly in healthcare?
Are we getting close to monopoly?
Or maybe monopoly. Not it's just what?
Not one dominant. There's like top three that
dominate the entire industry andthey collude on things.
(06:07):
So it's a lack of true competition in the market.
Right, because there's such opacity.
No, there's an information asymmetry.
You've got these big companies that set the prices for
everybody, and they know that not only does the patient not
know if their coinsurance or copay is reasonable, they don't
(06:28):
know what they're paying, right?They are overpaying.
In many cases. Many of our customers come to us
despite having insurance becausetheir copay or coinsurance are
so high, right? And then you have the employers
who are paying huge premium, their share of premiums is
getting bigger and bigger and they're having to pay the cost
not only for the the pharmaceuticals but also other
(06:49):
healthcare. They have no idea what they're
paying. Literally, Margaret, I'll sit
and talk to CEO's of companies and even though it's their
largest expense after payroll, they have no idea how their
benefits work. They have no idea what they're
paying for anything. And when I suggest that they go
and have it all audited by a third party, the the insurance
companies will not allow. It Are they hanging up against
(07:11):
you? They're trying, they all are
trying to replicate what we're doing, but they just.
Does it make it very difficult for an outside actor who's
operating in the free market trying to bring transparency to
marketplace? I mean, you're, you're really
David versus Goliath. They have no interest in letting
you. I'll give you the perfect
example, right? We sell 5000 SKU's, but there
(07:32):
are a bunch of brand medicationsthat we do not carry.
And it's not that those manufacturers of the brands
don't want to sell it to us. There's this thing called a
formulary. And what a formulary is, it
determines what your insurance company will pay for which drugs
your your your insurance companywill pay for.
And so they then. The formulary is the list of
drugs that the insurance companycarries.
(07:54):
Right? Correct.
Correct. And in order to get on a
formulary, the brand manufacturers compete to get on
that formulary. They literally pay not because
they're a better solution, but they pay to get carried.
They're paying for access. They're.
Paying for access, correct? And So what the big PBMS and the
insurance companies that own them are telling these brand
(08:14):
manufacturers is if you work with Cost Plus drugs and you
allow them to sell your branded medications, we are going to
diminish or eliminate your positioning on our formulary,
not just for the drugs you let Cost Plus carry, but for your
entire portfolio. This is unfair competition.
They're pushing you out of the marketplace because they don't
want your. Yes, I literally sat on the
(08:35):
stage for a private event with the CEO of 1 brand manufacturer
and I say said, shake your head twice if you would love to carry
cost plus, but you can't becauseof the PBMS.
And he was like, no, that would never happen.
Blink, blink, blink, blink. Yeah, I mean, you know, I had
another CEO of a brand manufacturer and I said, look,
how many lives do we have to cover?
(08:56):
How many potential patients? And he said half the market
because if you don't have half the market, we'll end up losing
significant monies from not being on the formularies.
OK, according to the Pete Peterson Foundation, brand name
drugs account for 8% of all the drugs that are dispensed, but
84% of drug costs, correct? How much difference can you make
(09:20):
in a marketplace without touching the most expensive?
Well, go back to what I just said, right, We would love to
cover and sell every drug that'sapproved by the FDA.
There's nothing we don't want tosell.
It's what we're allowed to sell if we.
And the reason they're stopping us is if you remember what I
said that when you go to costplusdrugs.com, we'll show
(09:40):
you our cost. We only mark it up 15%.
The big PBMS need to mark it up much more.
So if we were to carry the brands, then we what our cost
was net after rebates and only marked it up 15%, we'd
completely destabilize their pricing that's.
They're forcing you out of they want to keep you out of
competing with them for as long as they can.
(10:01):
OK, I want to ask you about pharmacy benefit managers.
PBM. PBM.
You've referred to them. They are the Darth Vader of the
Pharmaceutical industry. According to you, they call
themselves middle men between the insurance company and the
consumer. Me, I want to go get my drugs.
I have an insurance. I have a health insurance
company. I go to a pharmacy to buy drugs.
(10:21):
And apparently there's this thing called a pharmacy benefit
manager that is supposed to be looking out for the prices of
drugs. So it's supposed to be a
middleman, but the truth is the pharmacy benefit managers are
really owned by the insurance companies.
Or in one case owns an insurancecompany, so.
How can they be looking out for the prices if they're owned by
the insurance companies? They're not OK.
(10:42):
So, so they what is, what is therole they play in the system in
terms of preventing transparent competition?
We launched in January of 2022 and here we are more than four
years later. We are still the only pharmacy
that publishes a price list. OK, there's no reason why they
couldn't publish their prices. They choose not to.
(11:05):
It's just, you know, the more information patients and
employers have, the the less money they make.
So the PBMS, the pharmacy benefit managers argue that
actually the problem is the drugmanufacturers are jacking out
their prices, right, They say they point to data showing that
pharmaceutical companies have profit margins 8 times higher
(11:25):
than they do the pharmacy benefit managers.
So how do you how do you take onthat argument?
If that's true publisher prices,it's one thing to say it.
It's another thing to prove. It so they entirely benefit from
lack of transparency. Yeah, information asymmetry is
their best friend. OK.
The PBMS also say that taking away their rebates and
increasing reimbursements to pharmacies will only drive up
(11:47):
drug costs in the long run, no. Why no?
Because the net price is lower, right?
So not to get too inside baseball, but if these companies
came on Shark Tank, we would just tear them apart.
OK, so progressive Democrat Elizabeth Warren and
conservative Republican Josh Hawley, 2 senators, you know, if
one from Massachusetts, one fromMissouri, have introduced
(12:08):
legislation to break up the big insurance companies and prohibit
parent companies from owning both PBMS and medical providers.
So this is, this gets out what you've said is the entire
ecosystem, the whole supply chain, it was you said is
there's been this vertical consolidation of the healthcare.
And So what Elizabeth Warren andJosh Hawley want to do is break
(12:28):
up essentially the collusion in the industry, right?
So you, you, you've, you have called that, you've said you
support the bill. You've called supporting it a no
brainer, but you also say you want to break up the big
insurance companies. That's what they're talking
about, yeah. OK, but but they don't really
want to break up the companies. They want to break up the
collusion between all the parts of the healthcare and.
(12:50):
The other, OK, So what I would love to see happen is that they
divest all non insurance assets because they're able to game the
system. So for instance, there's this
thing called medical loss ratio that applies to different
insurance plans, particularly the ACA.
And what it says is of the premiums you collect, you have
to spend 80 to 85% of them on actual care.
(13:11):
Well, if you're paying, if you own the doctors effectively or
the the providers, you can tell them charge us more.
Because if you charge me more, Ihit my medical loss ratio
sooner. And if that profit stays in the
the hospital or the clinic, whatever it may be, it still
belongs to my company. So and so you need to get them
(13:32):
to divest all of these non insurance.
Asset consolidation up and down the supply chain.
Right, The pocket doesn't matter.
They don't care which company they profit in, as long as that
profit is somewhere in their vertical integration.
So this this doesn't so much break up the insurance companies
themselves from providing insurance, but it what it does
(13:52):
do is prevent it. Turns them back into insurance
companies. I see.
Now they're everything companiesand they can control everything.
Literally what those companies do defines the cost of
healthcare in this country. And if you want to get into the
details, I'm happy to because itstarts with the insurance plans.
So hear me out. So every year, if you get your
(14:13):
insurance from your employer or you go to the ACA marketplaces,
we all make choices as to what plans we'll buy, right, or
choose. And so we'll make, you know,
higher premium, lower premium, higher deductible there, right?
We just make that decision. But think about what happens in
an ACA plan now, particularly without the the premium tax
credits and ACA plan, Silver will have about a $5000
(14:36):
deductible. Well, if you don't have $5000,
you know, if you have a serious emergency, you don't have
insurance. And so the hospitals and
providers understand this. So if you can't afford your
deductible, they'll loan you themoney.
So immediately we've turned insurance hospitals rather and
providers into subprime lenders.And so now you've got all this
(15:00):
hospital debt that they that thethe patient has acquired and now
the hospital expects they're going to have to write off 50%
of that debt. So that's not the worst of it,
but that starts the the downwardspiral of cost.
Then you have the contracts between the insurance companies
(15:20):
and the hospitals, which President Trump set up so that
there has to be some transparency, right?
So you can go to the web page ofthe hospital and see what any
particular insurance plan has agreed to pay for, let's say, a
hip replacement, right? But here's the problem.
The insurance company doesn't pay what they contracted for.
(15:41):
They always underpay, late pay, clawback audit.
That just creates more costs forthe hospital.
So the hospitals now have to find new ways to replace that
revenue. So they create garbage fees like
facility fees. And then when you get your bill,
when you get released from the hospital, they charge, they
throw the kitchen sink at you hoping that you'll pay for it.
(16:04):
And most people, if you ever getthat bill, don't pay it right,
negotiate it down. But you create this negative
cascade that's all started with your insurance plan.
And if we were in a position where we, you only or could get
a plan where you could afford your deductible, none of this
downstream problems would happen.
And then we have prior authorizations.
(16:25):
Prior authorizations aren't evenabout denying claim for clinical
reasons. They're about delaying care
because the longer the insurancecompany delays, right, the more
interest they earn on the premiums.
All these things happen and you know who gets the worst of it?
The people with the least amountof leverage and information,
patients, independent pharmaciesand independent physicians.
(16:49):
Independent physicians are disappearing.
The people that have spent theirlives wanting to work in small
communities where if they retire, it's a it's a healthcare
desert. They get paid the least of
everybody, literally. So the insurance companies will
underpay them late, pay them clawback, knowing that if they
force them potentially go out ofbusiness, they can buy their
(17:11):
clinic or practice and take control of it.
So I've heard you say if you could, you know, if a magic wand
were waved, ultimately what we, what you would aspire to is that
we would have a healthcare system where everybody could get
the healthcare they need at a price they can afford.
Correct? Correct.
So if you were starting from scratch, what model would you
(17:34):
follow to deliver that? Well, first you need
transparency so people know whatthings cost.
You're saying the marketplace isn't, not isn't.
It's not The marketplace isn't the way to do it.
It's just that there isn't a fair marketplace.
There isn't a fair market. There's it's not an efficient
market right now for all the reasons I just mentioned with
the insurance companies and PDM.So if it's not a fair
marketplace, then if you're a proponent of universal
(17:56):
healthcare or single payer, there's no way to determine what
prices you will pay. And the challenge isn't whether
or not universal healthcare single payer is a good solution.
The question is, how do you get there, right?
So for instance, if we're able to remove all the middle men and
now all of a sudden hospitals can charge much less, they could
charge at Medicare rates and still make money, then a county,
(18:19):
a city, a state could say, OK, we've looked at all of our
claims. We can afford to pay this for
all of our residents. That's what happened in Canada
in 1947. That's how they started with
universal healthcare. And so we could go in that
direction. But if you don't know what the
costs are, that's Part 1. And Part 2 is because our system
(18:40):
is so geared towards integratingwith insurance companies, you
get the bigger the famous, the branded hospitals, the, you
know, Mayo Clinics, etcetera, who just have to up price
everything. They're the premium, right?
You can't just ask them to go touniversal healthcare because
they can't afford all the fancy machines, all the fancy doctors.
(19:03):
And so we would lose the creme de la creme of the care that we
offer in this country. So you need to be transparent
down to the contract level and in some cases down to every
accounting entry level. So what you've done is you've
identified a place in the systemdrug pricing where you you want
to try to reform it through transparency, by creating a
(19:25):
business that operates through transparency.
Have you found in your experience that doing this in
the marketplace will be enough to fix the marketplace?
Or is this going to require a legislative or policy fix?
In other words, can the market fix this problem right?
Or do you need policymakers to help you the.
(19:47):
Market can fix the problem, but it's going to take a lot long
time and people are going to die, you know, and so that's why
I'm a big fan of, you know, the big insurance companies having
to divest and then taking. You want a legislative fix or a
policy fix as a as a way of justexpediting them so.
If you can start with the insurance companies, then you go
to the big hospital systems because they all are leveraging
(20:09):
that information as asymmetry. And so we're doing everybody.
'S making money off. They're making money off of the
information asymmetry. Killing it, right?
And So what we're doing, we're not just about, you know, we
manufacture drugs as you said, right.
We also have our retail pharmacyin our in our pharmacy network,
But we've started to expand it. We created something called Cost
Plus Wellness. And what cost Plus Wellness is,
(20:32):
it allows companies to work around the insurance companies
and look at the contracts that we've posted on Cost Plus
Wellness and direct contract, which is exactly what I do for
my companies. So and, and you think that over
time you'll be able to to sort of carve out enough of the share
of the marketplace that you'll be able to compete with the big
insurance companies? So it's not so by doing cost
(20:55):
plus. Well, what take a step back.
So for my companies, I had all these conversations with
hospitals, PBM's, everybody, andI'm like, OK, let's talk about
the flow of money, right? It was like I put on my Shark
Tank hat and I went to them and they told me how they were
getting taken advantage of by the insurance companies.
So they pre, they late pay underpay, etcetera.
And so I went to them and said, look, what if I, we created a
(21:16):
contract where I wouldn't late pay, I would pay you on time,
I'd pay the contracted amount. There'd be no prior
authorizations because we would work that out beforehand.
And our employees would have no out of pocket cost at all.
So you wouldn't have to loan them any money or act as a
subprime lender. And they were like, great, when
where do we sign up? I'm like, but here's the thing,
(21:36):
I want better pricing. And they said, OK, we'll give
you better pricing because our costs go down.
And second, I said, I want to beable to publish our contract so
any company can replicate what we're doing.
And they were like a little bit hesitant because no one had ever
done that before. But we started publishing it and
now we have 9000 plus doctors and growing.
I don't even know how many contracts we have on cost plus
(21:58):
Wellness. But now we're seeing other
companies start to use those contracts for their own internal
contracting. And we literally have had
insurance companies come and sayyou got a better deal than we
did and we cover millions of lives.
And the reason we're able to geta better deal is because we
don't take on the the problems of the insurance companies.
(22:18):
These none of these hospitals orproviders like to work with the
insurance companies because theyunderpay, late pay, etcetera.
So if you keep going at the rateyou're going, how long will it
take you to disrupt the industry?
You know, we've been here four years, maybe five years more.
It's all about scale, right? Right.
To turn it upside down. But you also have big entrenched
interests that really don't wantyou to.
(22:39):
I know you don't care about it, but they're going to.
They're going to work hard to make sure you can't take out any
of the market share. That's what they do.
But as long as I have patients that we're saving money and
saving lives, they're going to tell each other nobody.
Look, when you talk to people about healthcare, most people
like their doctors, care about their doctors and feel doctors
care about them. When you ask them about the
economics of healthcare there, everybody hates it.
(23:01):
When you talk about insurance companies every, they're the
most hated industry in the country, right?
And so there's no love lost. So when you give people an
alternative, you may not be ableto get them to switch.
Everybody to be able to switch immediately, but slowly but
surely. Don't you think you're uniquely
positioned to do this because you said you don't even have a
marketing, but you don't even have a marketing budget,
correct, except for that you area marketing?
(23:22):
No, I've got a big mouth and a platform.
So you're right, yeah. Absolutely.
I'm in a very unique situation. My next dollar is not going to
change my life. There's nothing more.
This is like nothing that gets me more excited in the morning
after my family then coming in and wanting to F up the entire
healthcare industry because it certainly needs it.
In the State of the Union this week, Trump touted his big
(23:44):
achievement was bringing down the cost of drugs.
He launched Trump RX at the beginning of this month, early
February. This is a website that really,
you know it it. It helps patients find
medications either by buying them directly from the
manufacturer using a coupon. There are currently 43
medications available on Trump RX.
(24:06):
In some cases, there are cheapergeneric versions on your site.
You were pretty optimistic aboutTrump RX when it started.
How do you assess the execution?Look, there's no downside to
offering people less medicationsfor less price.
Less cost competition is better,right?
There's no downside to offering medications for a lower price.
Competition is better. So I'm all for Trump RX.
(24:28):
You know I don't. Republicans need medications
too. You know, I'm not into the but
Trump. RX is a government site intended
to offer drugs to all Americans,and that's not just Republican.
Right. No, that's great.
Right? Whatever.
And the point is whatever gets people lower priced medications,
yes, sign me up. We, we're the only pharmacy that
has an API that we publish everynight.
We're the only pharmacy. That stands for.
(24:49):
Automated programming interface,OK.
And so we're the only ones that publish our prices to anybody
who wants them. And we told Trump RX you have
access to our API, you can publish all of our prices and
where our prices are cheaper, publish them, use them, and
people will buy from us. Democrats published a report
this week about Trump RX, accusing it of misleading
(25:11):
Americans for not mentioning that lower cost generic versions
of some drugs are available in other places.
So Congressman Frank Pallone said that Trump RX is all hype
and no true action and and Ron Wyden said it's really a
glorified coupon book. Is is that fair?
I mean, it's it, it was a waste of time, it.
Was a waste of time. Just just plain, hey, Trump did
(25:33):
it, we hate it. There's no when it comes to this
stuff. Like a real criticism that, you
know, some of the, I mean, there's only 45 drugs on it.
You have so many more drugs on. Your side are cheaper on your
price and 26 of them, right? Yeah, so but it's just the
beginning, right? Give them a chance.
Anything that opens the door forlower price medications, I'm a
fan of. And so right now, 43 drugs is
(25:55):
not going to change the world, but it's a good starting point
and that we talk to other peopleall the time and we're working
with them to help get to the next level.
They've got some, you know, a guy named Chris Klump that works
underneath Doctor Oz now who's amazing.
So they've got some really good people who understand the
mission and will they get there all the way?
I don't know. But we're going to help them
wherever we can. The criticism from Liberty,
(26:17):
right? So the other side of the
political philosophy or political spectrum is that
you're injecting the government into the market where private
companies like yours are alreadyinnovating, right?
You guys are, you know, Cato Institute says that the
government runs sites risk introducing, quote, political
favoritism, coercion and regulatory corruption.
Is that a valid concern? Yeah, again, you know, shuffling
(26:40):
deck chairs on the Titanic because we're going to kick
their ass no matter what they do, so I'm not worried about
them. Like if I can't do better than
the government then somethings wrong.
So. So ultimately, it sounds like
you really think the marketplaceshould be able to fix this?
It's just a question of timing, you know, and in this particular
case, since it's healthcare, people die when it takes longer.
And that's the problem. If somebody can't afford their
(27:03):
medications because they're in their deductible phase and they
have to pay the full retail price, you know, even if they
have great insurance and they choose not to take their
insurance. I heard a story the other day
that just broke my heart. So somebody, a truck driver
couldn't afford to take their coagulant because he was going
to have to pay retail price eventhough he had a decent insurance
plan. You know during your deductible
(27:25):
phase, you pay a full list priceon it until you get to your
co-pay because you've reached your deductible.
Couldn't afford it. Had a hard instance while he was
driving his truck because he couldn't afford it.
Four people died because of the way the system is structured,
not because the, the price of the medication changed or it
(27:46):
went up. So he couldn't afford it.
No, it was just the, the structure of the way we price
branded medications in this country.
And that's a function of the insurance companies and their
PBMS and that they say anything to the contrary, they're lying
out their ass because it is there.
There's no reason why it needs to be this way.
(28:06):
And so can we get it done? Yes.
We're there's so many more things that we're doing that we
have won't even have time to talk about.
But in the meantime, are we willing to let people die?
Yeah, Remember Hillary care Yeah.
So this program Firing Line aired for 33 years.
William F Buckley Junior hosted it and and back when the Clinton
(28:28):
administration had come into office and Hillary Clinton and
the Clinton administration were taking on healthcare.
Sorry, for the first time in a generation, really.
Firing Line sponsored A4 part debate on on healthcare reform.
Okay, here is a clip from one ofthose debates.
Take a look. Cool.
The only plan that works, and that's Medicare, and none of the
(28:50):
people here would call that socialism or vote against it, is
just paying for It's the problem.
And the seniors love it. All the seniors love it, the
doctors like it, the hospitals survive with it, and it's about
to bankrupt the country. Not necessarily.
It's a plan that's there. Shoot at it if you choose, but
it has cost containment. It has all the features that all
(29:11):
of these wannabes would add, butit has the advantage of it.
It's empirical and works. You know, Democrats today are
still advocating for Medicare for All.
You have suggested That's unworkable.
To get there, Yeah. Not that it's a bad idea, but
it's going to be really hard, ifnot impossible to get there from
here. So what then is the ideal
(29:33):
solution? I'm a proponent of universal
healthcare, but again, you can'tjust go from here to there.
When you look at those other, however many countries that have
universal healthcare, the the most recent one I think is
Israel in 1995. And they're much smaller
countries. And so it's just what are you
going to say to Mayo Clinic? All of a sudden you're only
(29:54):
going to get Medicare rates for,you know, the best care that the
world offers. There's there's you have to come
up with a solution that they're involved in.
So that's one problem. The second problem is when you
read the the legislation that's been offered by Bernie Sanders
and Representative Jayapal, the first thing it says right at the
discretion of the secretary of Health and Human Services.
(30:19):
What's the problem with that? Well, you just don't know what
you're going to get. It's up to the president to
appoint whoever that is, and if they don't approach healthcare
the way that you think healthcare should be approached,
you've got a real problem. So you ultimately think the
marketplace should work this outas opposed to an individual in
government? No, not what I'm saying.
I'm saying that you have to lookin any trying to accomplish any
(30:42):
goal and the goal being to get healthcare that the least
possible cost to either the patient, the employer or the
taxpayer because one of those people is paying, right.
You have to know what the costs are and you have to know what
the obligations are. And there's no way in the
structure that we have right nowthat you can get from where we
(31:04):
are through the insurance companies and the PBMS, because
even right now, if you look at Medicare, there's Medicare
Advantage and Medicare Advantagewas supposed to cost less than
Medicare. And it has.
Been now it's $76 billion a yearmore.
But even within traditional Medicare, right, unless you get
supplemental insurance, which isoffered by an independent
(31:25):
insurance company, right, you'reat risk of having an unlimited
out of pocket cost. And so Medicare as we know it,
traditional Medicare as we know it today is not a perfect
solution. So when people say, well, we
just expand Medicare, you know, start from 65 to 60 to 50, no,
because you're still going to, you know, have very significant
problems unless you deal with the fact that there's unlimited
(31:48):
out of pocket costs. You've been pretty critical of
the president's tariffs. You called them basically just
gibberish. I want to go big picture, how
the tariffs have impacted the Pharmaceutical industry.
What has been the impact of Trump's tariffs on the
Pharmaceutical industry and drugproduction is because you said
last year any tariffs on goods imported from India, wood,
(32:11):
forest cost plus drugs to raise prices on medications.
Did that happen? No.
Why? They, the administration worked
out deals where we didn't see our prices go up and as our
volumes went up, our prices continued to go down.
So as you, I mean, you talked toCEOs, you talked to insurance,
you know the industry, what's your sort of assessment for how
(32:32):
the tariffs have impacted the atleast the drug?
Drug. Yeah, that's an interesting
question. I think he used them as a
negotiating tool and from that perspective, not an overall
economic perspective, but in terms of medications, they work
for him. And it's basically kept your
prices the same your. Prices, the people that he's
negotiated with are the brand medications and we don't have a
(32:52):
whole lot of access to them. But what I will add that it's
possible now using what we've learned with our manufacturing
in Dallas, we're able now to take that plus AI we created so
that we literally are able to manufacture all those generics
we buy from India. We can manufacture them less
expensively in Dallas, TX, except we have one issue.
(33:15):
That one issue is there's something called ANDA, which
when you want to manufacture a new generic, you have to go to
the FDA who has to approve your factory and they charge $365,000
for each drug. And so even though we're able to
move. Generics.
Even generics, right? And so we want to manufacture
1000 of them, that's $365 million, which destroys the
(33:37):
economic. So if we're able to get a
waiver, so if anybody from administration is watching, if
we're able to get a waiver, we'll be able to move the
manufacturing of those thousand generics to Dallas, TX and have
it up and running within 18 months.
Wouldn't that fit President Trump's onshoring effort to
ensure that, I mean, if we had another pandemic, we don't have
to worry about getting, you know, generic drugs from a. 100%
(33:59):
not only that, we put the whole thing to be able to manufacture
the pills, generic pills into a tractor trailer.
So if there is an environmental disaster or someone we can make
them and ship them to. So we're in the parking lot of
of and we've taken that same technology to keep on pulling
the string so that we can manufacture north of one
(34:20):
medication. Have you talked to RFK about
this? No, but I've talked to the
people that work directly for him and so they're aware of it
and you know, in a couple cases they're really supporting us.
And so I'm not going to criticize of other than the FDA
fees, but we've created and my partner Alex Ashmanski is just a
rocket scientist genius. And so we're able to take that
(34:41):
technology, expanded some with AI and some other things, and
we're able to manufacture north of 1 medications.
So when you hear all these heartbreaking stories about
people who have a disease, whereyour child has a disease and
there's only 12 people in the world, typically what happens?
The researchers get, you know, money that's been raised and
they start working on solutions.But when they need to turn that
into an actual medication, they have to hire these companies
(35:03):
that will charge a half $1,000,000 and take at least six
months with there are are pods that we've created.
We can cut that down to $50,000 and do it within three months.
And and that's getting faster and faster.
And because in Europe they have these laws where I think it's if
two doctors agree that this is aunique, a unique drug and
(35:26):
solution to a specific rare problem, then we can manufacture
for them. So we're hoping we can get the
same thing done in the United States.
So all these people, all these parents that are raising money
for their child because they have this rare disease and they
can't afford to even create the OR know path we'll be able to
solve that problem. And we're starting, you know, we
have a first child from Italy that we're trying to work this
(35:50):
all out for. So when you talk about, you
know, government intervention and can we compete, Yes, we can
absolutely compete. We can absolutely change
healthcare. We can absolutely change the
economics of healthcare, but we're going to have to fight all
these huge insurance companies and can we do it?
Yes, we've done it so far and they're copying us rather than
(36:11):
vice versa. But the more help we get, the
faster we can go. One of the things I admire so
much about you, you're you're clearly a problem solver.
You want to fix things, but you also have a servant's heart.
And, and you, you care about this country and you care about
solving problems. In 2024, you can you campaigned
with Vice President Kamala Harris, who you endorsed.
But having now had a chance to reflect on this, and I just, I
(36:34):
know that, you know, Democrats from across the country are
coming to you saying, what should Democrats be doing
differently? What are Democrats going to be
getting wrong? You have said Democrats can't
sell anything. I mean, here you are selling an
idea, selling reform, selling healthcare, selling cheaper drug
prices. What are Democrats getting
wrong, though? Like, what can they learn from
you? Like what?
How do you assess? Yeah, you have to be a problem
(36:56):
solver first. Democrats used to be a party of
entrepreneurs. They no longer are.
You know, it used to be people that were part of the party were
focused on solving the problem as opposed to creating policy
first, because policy, creating policy in this environment
particularly is all about getting elected first as opposed
to solving problems. And I think they've got it
(37:17):
backwards. I think you have to solve
problems, which demonstrates to voters that you're able to solve
problems and that they support people who can't.
Think Kamala wasn't able to do that?
She, Kamala wasn't that. She wasn't able to do that.
She wasn't given the opportunityright to, to pitch any of that.
They couldn't. Democrats If you gave the
Democrats a chance to sell dollar bills for $0.50, they
(37:40):
would try to pass a law that made it happen before just doing
it. One of the things you've pointed
out, you've pointed to Donald Trump, Zoran Mandani, James
Talarico, the the candidate who's running for Senate in
Texas as as individuals who can leverage the attention economy
effectively. Yes.
Is that what any candidate needsto be able to do?
Absolutely. I mean, that's, that's what
you're doing. Yeah, I mean, other than
(38:01):
everybody watching Firing Line and with Margaret Hoover, I mean
people, particularly younger people, get most of their
information from their social media feeds.
Well, and that's what I see you putting Twitter, you know, X ING
out, tweeting out, you know, andyou're you're name checking
Laura Bloomer AOC all in the same tweet because you're trying
to pull people together on this on this idea of healthcare.
(38:24):
So to be a successful Democrat in the next wave.
I mean, I know they're asking you for advice.
Are you telling them yes, you have to win at this attention?
Game, yes, you have to understand that in an
algorithmic world where people get almost all of their
information via social media, even older people, right?
I mean, they're on Facebook all day long.
Everybody has their own individual feed.
(38:45):
If you want to know what a person's all about, look at what
their Instagram or TikTok or Facebook feed is.
And if you don't flood the zone,to quote Steve Bannon, right, if
you don't flood the zone and do things that gain the attention
of the algorithm and have it feed people, you're, you're
forgotten, you're lost. Look at when Donald Trump was
(39:06):
saying they're eating cats and dogs.
It wasn't because he thought people were literally eating
cats and dogs. He knew he was smart enough to
know. That's how you get attention in
an algorithmic world. Mandami here in New York, right?
He's Trump Junior. He's a little clone of Trump.
You know, James Talarico and Mandami, you know what they have
in common now? They both grew up in an era
(39:27):
where Donald Trump was the dominant politician that was
dominated by social media. And you look in Mandami
brilliant at social media, right?
I told the Democrats they shouldhire his team, pay him $10
million each to take them from him because that'll get them
further along than buying $50 million worth of ads on linear
media. OK, You've said 100 times you
(39:48):
are not going to run for president, correct?
Unless, yeah, Donald Trump runs for a third term.
Yeah, which I don't think you really believe he's going to do.
But he joked about it in the State of the Union this week.
That should have been his third term.
Right, right, right. I mean, is that, is that your
way of saying there's no way youreally ever run?
True, yes. So you and are you Democrat or
Republican now I'm. Independent, I think for myself.
(40:10):
So you'd never consider an independent because there's it's
you looked for an independent run at, you looked at an
independent run for president in2020.
No, I considered it, Yeah, just because people were asking me
about it and I thought it was flat.
Well, they. Haven't stopped asking.
No, I mean, I see polls all the time and people send me that.
There's a lot of private pollingthat suggests that you would be
the best candidate for the Democratic Party.
Yeah, I don't know that I'd wantto run as a Democrat.
(40:32):
I mean, I think would be more fun to run as a Republican just
to try to turn things upside down.
But I think I, I, you know, I, Ithink I would have a chance, a
puncher's chance, but I think I'd have the best chance by
being an independent. And the reason for that is
people are sick of the Republicans.
People are sick of the Democrats.
We're, we're sick of everybody just taking their own side and
(40:54):
just being divided as a country.And I think by saying as an
independent, yeah, I agree, the Republicans suck and the
Democrats suck. Let's bring people together and
focus on solving problems. Because by definition, anything
that an independent president does would have to be
bipartisan. It's so inspirational, but I
know you looked at it. Did you ultimately decide that
an independent, it's just so difficult mechanically in the
(41:17):
country for an independent to win because I think it's thrown
to the House of Representatives and.
No, I talked to my family and they all voted against it.
That was 100%. Who has the true veto in the
Cuban House? The whole family, not me, that's
for sure. Well, kids will be older in a
little while. Mark Cuban, thank you for
joining me on FIRING LINE. Thanks for what you're trying to
do to have. Margaret, it was a lot of fun.
Thank you. Thanks.
There's an information asymmetry, literally, Margaret.
I'll sit and talk to CE OS of companies and even though it's
their largest expense after payroll, they have no idea how
their benefits work. They have no idea what they're
paying for anything. And when I suggest that they go
and have it all audited by a third party, the insurance
companies will not allow it. That's billionaire entrepreneur
(00:23):
Mark Cuban explaining what he believes is wrong with
healthcare in America. I'm Margaret Hoover.
This is the FIRING Line podcast.Mark Cuban found success as an
Internet pioneer, as an outspoken owner of the Dallas
Mavericks and as a star of ABC'sShark Tank.
(00:44):
I'll give you the $400,000, but I want 16%.
But now he is dedicating his focus and his money to
disrupting the healthcare industry.
There's nothing that gets me more excited in the morning
after my family than coming in and wanting to F up the entire
healthcare industry. In 2022, Cuban launched Cost
Plus Drugs to offer prescriptionmedications at low prices and to
(01:07):
undercut the insurance industry middleman that he blames for
skyrocketing costs. There is no reason why it needs
to be this way. And so can we get it done?
Yes. But in the meantime, are we
willing to let people die? But what does Mark Cuban make of
President Trump's efforts to shake up the system?
So I'm all for Trump RX whatevergets people lower priced
(01:29):
medications. Yes, sign me up.
Mark Cuban, welcome back to FIRING LINE.
Thank you for having me. Over the last 40 years in the
United States, drug costs have increased 3 times the rate of
inflation. In 2022, US drug prices were
nearly three times higher than comparable developed countries.
(01:51):
And in President Trump's State of the Union address this week,
Trump called healthcare costs, quote one of the biggest RIP
offs of our time. Why are Americans getting ripped
off? Well, the one thing from a
business perspective that differentiates the United States
versus all the other developed nations when it comes to drugs,
(02:12):
we have these things called pharmacy benefit managers.
They don't, Period. End of story.
PBMS, pharmacy benefit managers who are purportedly middle men
between your insurance company and your pharmacy.
Right In 2018, you got this e-mail from a radiologist
complaining about drug prices. Four years later you start your
own company cost plus drugs and and it and it is intended to
(02:35):
offer fair price drugs, generic drugs to the public directly
without having to go through a middle man.
You are now today selling thousands of drugs to millions
of customers and you have your own factory manufacturing
medicines. So in layman's terms, what is
the problem that your company issolving?
(02:56):
We're transparent. When you go to
costplusdrugs.com, you put in the name of the medication.
If it's one of the thousands we carry comes up and we show you
our actual cost, our little actual cost, we show you our
markup, which is only 15%. And if it's mail order, it's $5
to ship it to you, that's it. And so any medication that you
make it prescribed, you can check our price 1st.
(03:18):
And here we are four years laterfrom our launch.
We're still the only pharmacy that publishes a price list and
we update our update our price list every day.
Let's take a concrete example, Imatinib.
Imatinib is a drug that treats chronic myeloid leukemia, right?
OK. Today on Goodrx, the pharmacy
prices it for 30 pills, 400 milligram tablets.
(03:39):
The range is from $94.00 to $4000.
On your site cost plus drugs it's $34.50.
Why? Because good RX works inside the
system and they work with PBM, they work with the insurance
companies, right by going to cost plus Drugs.com, we charge
the same price to everybody. When our costs go down, we pass
(04:02):
through the the lower price. So first.
I don't go to cost plus blood drugs.
I don't actually know how much my drugs cost.
Pretty much, yeah. And so not only do you not know
what your drugs are going to cost, your employer doesn't know
what they're paying for the drugs that you are using.
So that's Part 1 transparency. Part 2 is fairness and pricing.
(04:22):
We only mark it up 15%. And because we only mark it up
15%, people trust us. You know, there's there's
something I heard that really stayed with me.
They said there's a there's a formula for trust.
It says trust equals transparency divided by
self-interest. The more transparent you are,
the higher the numerator. The less self-interest you have,
(04:44):
the bigger the total number. By only marking up 15%.
People trust us and that's why they come to us.
We spend no money on marketing. 0 Not a penny.
It sounds like what you're saying is you've identified that
the problem is that an average consumer of drugs of
pharmaceuticals has no idea whatthey cost because they have
employer provided healthcare or they have some other kind of
(05:05):
healthcare benefit that just gives them their drugs for a
certain price, but they don't know the actual rate.
So it's a is what you're trying to solve a market problem?
Yes, it's it's the way the industry is structured.
Why have drugs gotten so expensive over the last 40
years? The way the industry is
structured is you have these enormous insurance companies
(05:26):
that in turn have, you know, thebiggest insurance company in the
country has 2600 subsidiaries through and they have $160
billion in intercompany transfers and that out there so
big and they're you know, they own doctors providers, park
pharmacy benefit managers, some cases pharmacies, specialty
(05:47):
pharmacies. They are so vertically
integrated. They literally control and set
the pricing of all the economicsis there in all of healthcare,
not just. Monopoly in healthcare?
Are we getting close to monopoly?
Or maybe monopoly. Not it's just what?
Not one dominant. There's like top three that
dominate the entire industry andthey collude on things.
(06:07):
So it's a lack of true competition in the market.
Right, because there's such opacity.
No, there's an information asymmetry.
You've got these big companies that set the prices for
everybody, and they know that not only does the patient not
know if their coinsurance or copay is reasonable, they don't
(06:28):
know what they're paying, right?They are overpaying.
In many cases. Many of our customers come to us
despite having insurance becausetheir copay or coinsurance are
so high, right? And then you have the employers
who are paying huge premium, their share of premiums is
getting bigger and bigger and they're having to pay the cost
not only for the the pharmaceuticals but also other
(06:49):
healthcare. They have no idea what they're
paying. Literally, Margaret, I'll sit
and talk to CEO's of companies and even though it's their
largest expense after payroll, they have no idea how their
benefits work. They have no idea what they're
paying for anything. And when I suggest that they go
and have it all audited by a third party, the the insurance
companies will not allow. It Are they hanging up against
(07:11):
you? They're trying, they all are
trying to replicate what we're doing, but they just.
Does it make it very difficult for an outside actor who's
operating in the free market trying to bring transparency to
marketplace? I mean, you're, you're really
David versus Goliath. They have no interest in letting
you. I'll give you the perfect
example, right? We sell 5000 SKU's, but there
(07:32):
are a bunch of brand medicationsthat we do not carry.
And it's not that those manufacturers of the brands
don't want to sell it to us. There's this thing called a
formulary. And what a formulary is, it
determines what your insurance company will pay for which drugs
your your your insurance companywill pay for.
And so they then. The formulary is the list of
drugs that the insurance companycarries.
(07:54):
Right? Correct.
Correct. And in order to get on a
formulary, the brand manufacturers compete to get on
that formulary. They literally pay not because
they're a better solution, but they pay to get carried.
They're paying for access. They're.
Paying for access, correct? And So what the big PBMS and the
insurance companies that own them are telling these brand
(08:14):
manufacturers is if you work with Cost Plus drugs and you
allow them to sell your branded medications, we are going to
diminish or eliminate your positioning on our formulary,
not just for the drugs you let Cost Plus carry, but for your
entire portfolio. This is unfair competition.
They're pushing you out of the marketplace because they don't
want your. Yes, I literally sat on the
(08:35):
stage for a private event with the CEO of 1 brand manufacturer
and I say said, shake your head twice if you would love to carry
cost plus, but you can't becauseof the PBMS.
And he was like, no, that would never happen.
Blink, blink, blink, blink. Yeah, I mean, you know, I had
another CEO of a brand manufacturer and I said, look,
how many lives do we have to cover?
(08:56):
How many potential patients? And he said half the market
because if you don't have half the market, we'll end up losing
significant monies from not being on the formularies.
OK, according to the Pete Peterson Foundation, brand name
drugs account for 8% of all the drugs that are dispensed, but
84% of drug costs, correct? How much difference can you make
(09:20):
in a marketplace without touching the most expensive?
Well, go back to what I just said, right, We would love to
cover and sell every drug that'sapproved by the FDA.
There's nothing we don't want tosell.
It's what we're allowed to sell if we.
And the reason they're stopping us is if you remember what I
said that when you go to costplusdrugs.com, we'll show
(09:40):
you our cost. We only mark it up 15%.
The big PBMS need to mark it up much more.
So if we were to carry the brands, then we what our cost
was net after rebates and only marked it up 15%, we'd
completely destabilize their pricing that's.
They're forcing you out of they want to keep you out of
competing with them for as long as they can.
(10:01):
OK, I want to ask you about pharmacy benefit managers.
PBM. PBM.
You've referred to them. They are the Darth Vader of the
Pharmaceutical industry. According to you, they call
themselves middle men between the insurance company and the
consumer. Me, I want to go get my drugs.
I have an insurance. I have a health insurance
company. I go to a pharmacy to buy drugs.
(10:21):
And apparently there's this thing called a pharmacy benefit
manager that is supposed to be looking out for the prices of
drugs. So it's supposed to be a
middleman, but the truth is the pharmacy benefit managers are
really owned by the insurance companies.
Or in one case owns an insurancecompany, so.
How can they be looking out for the prices if they're owned by
the insurance companies? They're not OK.
(10:42):
So, so they what is, what is therole they play in the system in
terms of preventing transparent competition?
We launched in January of 2022 and here we are more than four
years later. We are still the only pharmacy
that publishes a price list. OK, there's no reason why they
couldn't publish their prices. They choose not to.
(11:05):
It's just, you know, the more information patients and
employers have, the the less money they make.
So the PBMS, the pharmacy benefit managers argue that
actually the problem is the drugmanufacturers are jacking out
their prices, right, They say they point to data showing that
pharmaceutical companies have profit margins 8 times higher
(11:25):
than they do the pharmacy benefit managers.
So how do you how do you take onthat argument?
If that's true publisher prices,it's one thing to say it.
It's another thing to prove. It so they entirely benefit from
lack of transparency. Yeah, information asymmetry is
their best friend. OK.
The PBMS also say that taking away their rebates and
increasing reimbursements to pharmacies will only drive up
(11:47):
drug costs in the long run, no. Why no?
Because the net price is lower, right?
So not to get too inside baseball, but if these companies
came on Shark Tank, we would just tear them apart.
OK, so progressive Democrat Elizabeth Warren and
conservative Republican Josh Hawley, 2 senators, you know, if
one from Massachusetts, one fromMissouri, have introduced
(12:08):
legislation to break up the big insurance companies and prohibit
parent companies from owning both PBMS and medical providers.
So this is, this gets out what you've said is the entire
ecosystem, the whole supply chain, it was you said is
there's been this vertical consolidation of the healthcare.
And So what Elizabeth Warren andJosh Hawley want to do is break
(12:28):
up essentially the collusion in the industry, right?
So you, you, you've, you have called that, you've said you
support the bill. You've called supporting it a no
brainer, but you also say you want to break up the big
insurance companies. That's what they're talking
about, yeah. OK, but but they don't really
want to break up the companies. They want to break up the
collusion between all the parts of the healthcare and.
(12:50):
The other, OK, So what I would love to see happen is that they
divest all non insurance assets because they're able to game the
system. So for instance, there's this
thing called medical loss ratio that applies to different
insurance plans, particularly the ACA.
And what it says is of the premiums you collect, you have
to spend 80 to 85% of them on actual care.
(13:11):
Well, if you're paying, if you own the doctors effectively or
the the providers, you can tell them charge us more.
Because if you charge me more, Ihit my medical loss ratio
sooner. And if that profit stays in the
the hospital or the clinic, whatever it may be, it still
belongs to my company. So and so you need to get them
(13:32):
to divest all of these non insurance.
Asset consolidation up and down the supply chain.
Right, The pocket doesn't matter.
They don't care which company they profit in, as long as that
profit is somewhere in their vertical integration.
So this this doesn't so much break up the insurance companies
themselves from providing insurance, but it what it does
(13:52):
do is prevent it. Turns them back into insurance
companies. I see.
Now they're everything companiesand they can control everything.
Literally what those companies do defines the cost of
healthcare in this country. And if you want to get into the
details, I'm happy to because itstarts with the insurance plans.
So hear me out. So every year, if you get your
(14:13):
insurance from your employer or you go to the ACA marketplaces,
we all make choices as to what plans we'll buy, right, or
choose. And so we'll make, you know,
higher premium, lower premium, higher deductible there, right?
We just make that decision. But think about what happens in
an ACA plan now, particularly without the the premium tax
credits and ACA plan, Silver will have about a $5000
(14:36):
deductible. Well, if you don't have $5000,
you know, if you have a serious emergency, you don't have
insurance. And so the hospitals and
providers understand this. So if you can't afford your
deductible, they'll loan you themoney.
So immediately we've turned insurance hospitals rather and
providers into subprime lenders.And so now you've got all this
(15:00):
hospital debt that they that thethe patient has acquired and now
the hospital expects they're going to have to write off 50%
of that debt. So that's not the worst of it,
but that starts the the downwardspiral of cost.
Then you have the contracts between the insurance companies
(15:20):
and the hospitals, which President Trump set up so that
there has to be some transparency, right?
So you can go to the web page ofthe hospital and see what any
particular insurance plan has agreed to pay for, let's say, a
hip replacement, right? But here's the problem.
The insurance company doesn't pay what they contracted for.
(15:41):
They always underpay, late pay, clawback audit.
That just creates more costs forthe hospital.
So the hospitals now have to find new ways to replace that
revenue. So they create garbage fees like
facility fees. And then when you get your bill,
when you get released from the hospital, they charge, they
throw the kitchen sink at you hoping that you'll pay for it.
(16:04):
And most people, if you ever getthat bill, don't pay it right,
negotiate it down. But you create this negative
cascade that's all started with your insurance plan.
And if we were in a position where we, you only or could get
a plan where you could afford your deductible, none of this
downstream problems would happen.
And then we have prior authorizations.
(16:25):
Prior authorizations aren't evenabout denying claim for clinical
reasons. They're about delaying care
because the longer the insurancecompany delays, right, the more
interest they earn on the premiums.
All these things happen and you know who gets the worst of it?
The people with the least amountof leverage and information,
patients, independent pharmaciesand independent physicians.
(16:49):
Independent physicians are disappearing.
The people that have spent theirlives wanting to work in small
communities where if they retire, it's a it's a healthcare
desert. They get paid the least of
everybody, literally. So the insurance companies will
underpay them late, pay them clawback, knowing that if they
force them potentially go out ofbusiness, they can buy their
(17:11):
clinic or practice and take control of it.
So I've heard you say if you could, you know, if a magic wand
were waved, ultimately what we, what you would aspire to is that
we would have a healthcare system where everybody could get
the healthcare they need at a price they can afford.
Correct? Correct.
So if you were starting from scratch, what model would you
(17:34):
follow to deliver that? Well, first you need
transparency so people know whatthings cost.
You're saying the marketplace isn't, not isn't.
It's not The marketplace isn't the way to do it.
It's just that there isn't a fair marketplace.
There isn't a fair market. There's it's not an efficient
market right now for all the reasons I just mentioned with
the insurance companies and PDM.So if it's not a fair
marketplace, then if you're a proponent of universal
(17:56):
healthcare or single payer, there's no way to determine what
prices you will pay. And the challenge isn't whether
or not universal healthcare single payer is a good solution.
The question is, how do you get there, right?
So for instance, if we're able to remove all the middle men and
now all of a sudden hospitals can charge much less, they could
charge at Medicare rates and still make money, then a county,
(18:19):
a city, a state could say, OK, we've looked at all of our
claims. We can afford to pay this for
all of our residents. That's what happened in Canada
in 1947. That's how they started with
universal healthcare. And so we could go in that
direction. But if you don't know what the
costs are, that's Part 1. And Part 2 is because our system
(18:40):
is so geared towards integratingwith insurance companies, you
get the bigger the famous, the branded hospitals, the, you
know, Mayo Clinics, etcetera, who just have to up price
everything. They're the premium, right?
You can't just ask them to go touniversal healthcare because
they can't afford all the fancy machines, all the fancy doctors.
(19:03):
And so we would lose the creme de la creme of the care that we
offer in this country. So you need to be transparent
down to the contract level and in some cases down to every
accounting entry level. So what you've done is you've
identified a place in the systemdrug pricing where you you want
to try to reform it through transparency, by creating a
(19:25):
business that operates through transparency.
Have you found in your experience that doing this in
the marketplace will be enough to fix the marketplace?
Or is this going to require a legislative or policy fix?
In other words, can the market fix this problem right?
Or do you need policymakers to help you the.
(19:47):
Market can fix the problem, but it's going to take a lot long
time and people are going to die, you know, and so that's why
I'm a big fan of, you know, the big insurance companies having
to divest and then taking. You want a legislative fix or a
policy fix as a as a way of justexpediting them so.
If you can start with the insurance companies, then you go
to the big hospital systems because they all are leveraging
(20:09):
that information as asymmetry. And so we're doing everybody.
'S making money off. They're making money off of the
information asymmetry. Killing it, right?
And So what we're doing, we're not just about, you know, we
manufacture drugs as you said, right.
We also have our retail pharmacyin our in our pharmacy network,
But we've started to expand it. We created something called Cost
Plus Wellness. And what cost Plus Wellness is,
(20:32):
it allows companies to work around the insurance companies
and look at the contracts that we've posted on Cost Plus
Wellness and direct contract, which is exactly what I do for
my companies. So and, and you think that over
time you'll be able to to sort of carve out enough of the share
of the marketplace that you'll be able to compete with the big
insurance companies? So it's not so by doing cost
(20:55):
plus. Well, what take a step back.
So for my companies, I had all these conversations with
hospitals, PBM's, everybody, andI'm like, OK, let's talk about
the flow of money, right? It was like I put on my Shark
Tank hat and I went to them and they told me how they were
getting taken advantage of by the insurance companies.
So they pre, they late pay underpay, etcetera.
And so I went to them and said, look, what if I, we created a
(21:16):
contract where I wouldn't late pay, I would pay you on time,
I'd pay the contracted amount. There'd be no prior
authorizations because we would work that out beforehand.
And our employees would have no out of pocket cost at all.
So you wouldn't have to loan them any money or act as a
subprime lender. And they were like, great, when
where do we sign up? I'm like, but here's the thing,
(21:36):
I want better pricing. And they said, OK, we'll give
you better pricing because our costs go down.
And second, I said, I want to beable to publish our contract so
any company can replicate what we're doing.
And they were like a little bit hesitant because no one had ever
done that before. But we started publishing it and
now we have 9000 plus doctors and growing.
I don't even know how many contracts we have on cost plus
(21:58):
Wellness. But now we're seeing other
companies start to use those contracts for their own internal
contracting. And we literally have had
insurance companies come and sayyou got a better deal than we
did and we cover millions of lives.
And the reason we're able to geta better deal is because we
don't take on the the problems of the insurance companies.
(22:18):
These none of these hospitals orproviders like to work with the
insurance companies because theyunderpay, late pay, etcetera.
So if you keep going at the rateyou're going, how long will it
take you to disrupt the industry?
You know, we've been here four years, maybe five years more.
It's all about scale, right? Right.
To turn it upside down. But you also have big entrenched
interests that really don't wantyou to.
(22:39):
I know you don't care about it, but they're going to.
They're going to work hard to make sure you can't take out any
of the market share. That's what they do.
But as long as I have patients that we're saving money and
saving lives, they're going to tell each other nobody.
Look, when you talk to people about healthcare, most people
like their doctors, care about their doctors and feel doctors
care about them. When you ask them about the
economics of healthcare there, everybody hates it.
(23:01):
When you talk about insurance companies every, they're the
most hated industry in the country, right?
And so there's no love lost. So when you give people an
alternative, you may not be ableto get them to switch.
Everybody to be able to switch immediately, but slowly but
surely. Don't you think you're uniquely
positioned to do this because you said you don't even have a
marketing, but you don't even have a marketing budget,
correct, except for that you area marketing?
(23:22):
No, I've got a big mouth and a platform.
So you're right, yeah. Absolutely.
I'm in a very unique situation. My next dollar is not going to
change my life. There's nothing more.
This is like nothing that gets me more excited in the morning
after my family then coming in and wanting to F up the entire
healthcare industry because it certainly needs it.
In the State of the Union this week, Trump touted his big
(23:44):
achievement was bringing down the cost of drugs.
He launched Trump RX at the beginning of this month, early
February. This is a website that really,
you know it it. It helps patients find
medications either by buying them directly from the
manufacturer using a coupon. There are currently 43
medications available on Trump RX.
(24:06):
In some cases, there are cheapergeneric versions on your site.
You were pretty optimistic aboutTrump RX when it started.
How do you assess the execution?Look, there's no downside to
offering people less medicationsfor less price.
Less cost competition is better,right?
There's no downside to offering medications for a lower price.
Competition is better. So I'm all for Trump RX.
(24:28):
You know I don't. Republicans need medications
too. You know, I'm not into the but
Trump. RX is a government site intended
to offer drugs to all Americans,and that's not just Republican.
Right. No, that's great.
Right? Whatever.
And the point is whatever gets people lower priced medications,
yes, sign me up. We, we're the only pharmacy that
has an API that we publish everynight.
We're the only pharmacy. That stands for.
(24:49):
Automated programming interface,OK.
And so we're the only ones that publish our prices to anybody
who wants them. And we told Trump RX you have
access to our API, you can publish all of our prices and
where our prices are cheaper, publish them, use them, and
people will buy from us. Democrats published a report
this week about Trump RX, accusing it of misleading
(25:11):
Americans for not mentioning that lower cost generic versions
of some drugs are available in other places.
So Congressman Frank Pallone said that Trump RX is all hype
and no true action and and Ron Wyden said it's really a
glorified coupon book. Is is that fair?
I mean, it's it, it was a waste of time, it.
Was a waste of time. Just just plain, hey, Trump did
(25:33):
it, we hate it. There's no when it comes to this
stuff. Like a real criticism that, you
know, some of the, I mean, there's only 45 drugs on it.
You have so many more drugs on. Your side are cheaper on your
price and 26 of them, right? Yeah, so but it's just the
beginning, right? Give them a chance.
Anything that opens the door forlower price medications, I'm a
fan of. And so right now, 43 drugs is
(25:55):
not going to change the world, but it's a good starting point
and that we talk to other peopleall the time and we're working
with them to help get to the next level.
They've got some, you know, a guy named Chris Klump that works
underneath Doctor Oz now who's amazing.
So they've got some really good people who understand the
mission and will they get there all the way?
I don't know. But we're going to help them
wherever we can. The criticism from Liberty,
(26:17):
right? So the other side of the
political philosophy or political spectrum is that
you're injecting the government into the market where private
companies like yours are alreadyinnovating, right?
You guys are, you know, Cato Institute says that the
government runs sites risk introducing, quote, political
favoritism, coercion and regulatory corruption.
Is that a valid concern? Yeah, again, you know, shuffling
(26:40):
deck chairs on the Titanic because we're going to kick
their ass no matter what they do, so I'm not worried about
them. Like if I can't do better than
the government then somethings wrong.
So. So ultimately, it sounds like
you really think the marketplaceshould be able to fix this?
It's just a question of timing, you know, and in this particular
case, since it's healthcare, people die when it takes longer.
And that's the problem. If somebody can't afford their
(27:03):
medications because they're in their deductible phase and they
have to pay the full retail price, you know, even if they
have great insurance and they choose not to take their
insurance. I heard a story the other day
that just broke my heart. So somebody, a truck driver
couldn't afford to take their coagulant because he was going
to have to pay retail price eventhough he had a decent insurance
plan. You know during your deductible
(27:25):
phase, you pay a full list priceon it until you get to your
co-pay because you've reached your deductible.
Couldn't afford it. Had a hard instance while he was
driving his truck because he couldn't afford it.
Four people died because of the way the system is structured,
not because the, the price of the medication changed or it
(27:46):
went up. So he couldn't afford it.
No, it was just the, the structure of the way we price
branded medications in this country.
And that's a function of the insurance companies and their
PBMS and that they say anything to the contrary, they're lying
out their ass because it is there.
There's no reason why it needs to be this way.
(28:06):
And so can we get it done? Yes.
We're there's so many more things that we're doing that we
have won't even have time to talk about.
But in the meantime, are we willing to let people die?
Yeah, Remember Hillary care Yeah.
So this program Firing Line aired for 33 years.
William F Buckley Junior hosted it and and back when the Clinton
(28:28):
administration had come into office and Hillary Clinton and
the Clinton administration were taking on healthcare.
Sorry, for the first time in a generation, really.
Firing Line sponsored A4 part debate on on healthcare reform.
Okay, here is a clip from one ofthose debates.
Take a look. Cool.
The only plan that works, and that's Medicare, and none of the
(28:50):
people here would call that socialism or vote against it, is
just paying for It's the problem.
And the seniors love it. All the seniors love it, the
doctors like it, the hospitals survive with it, and it's about
to bankrupt the country. Not necessarily.
It's a plan that's there. Shoot at it if you choose, but
it has cost containment. It has all the features that all
(29:11):
of these wannabes would add, butit has the advantage of it.
It's empirical and works. You know, Democrats today are
still advocating for Medicare for All.
You have suggested That's unworkable.
To get there, Yeah. Not that it's a bad idea, but
it's going to be really hard, ifnot impossible to get there from
here. So what then is the ideal
(29:33):
solution? I'm a proponent of universal
healthcare, but again, you can'tjust go from here to there.
When you look at those other, however many countries that have
universal healthcare, the the most recent one I think is
Israel in 1995. And they're much smaller
countries. And so it's just what are you
going to say to Mayo Clinic? All of a sudden you're only
(29:54):
going to get Medicare rates for,you know, the best care that the
world offers. There's there's you have to come
up with a solution that they're involved in.
So that's one problem. The second problem is when you
read the the legislation that's been offered by Bernie Sanders
and Representative Jayapal, the first thing it says right at the
discretion of the secretary of Health and Human Services.
(30:19):
What's the problem with that? Well, you just don't know what
you're going to get. It's up to the president to
appoint whoever that is, and if they don't approach healthcare
the way that you think healthcare should be approached,
you've got a real problem. So you ultimately think the
marketplace should work this outas opposed to an individual in
government? No, not what I'm saying.
I'm saying that you have to lookin any trying to accomplish any
(30:42):
goal and the goal being to get healthcare that the least
possible cost to either the patient, the employer or the
taxpayer because one of those people is paying, right.
You have to know what the costs are and you have to know what
the obligations are. And there's no way in the
structure that we have right nowthat you can get from where we
(31:04):
are through the insurance companies and the PBMS, because
even right now, if you look at Medicare, there's Medicare
Advantage and Medicare Advantagewas supposed to cost less than
Medicare. And it has.
Been now it's $76 billion a yearmore.
But even within traditional Medicare, right, unless you get
supplemental insurance, which isoffered by an independent
(31:25):
insurance company, right, you'reat risk of having an unlimited
out of pocket cost. And so Medicare as we know it,
traditional Medicare as we know it today is not a perfect
solution. So when people say, well, we
just expand Medicare, you know, start from 65 to 60 to 50, no,
because you're still going to, you know, have very significant
problems unless you deal with the fact that there's unlimited
(31:48):
out of pocket costs. You've been pretty critical of
the president's tariffs. You called them basically just
gibberish. I want to go big picture, how
the tariffs have impacted the Pharmaceutical industry.
What has been the impact of Trump's tariffs on the
Pharmaceutical industry and drugproduction is because you said
last year any tariffs on goods imported from India, wood,
(32:11):
forest cost plus drugs to raise prices on medications.
Did that happen? No.
Why? They, the administration worked
out deals where we didn't see our prices go up and as our
volumes went up, our prices continued to go down.
So as you, I mean, you talked toCEOs, you talked to insurance,
you know the industry, what's your sort of assessment for how
(32:32):
the tariffs have impacted the atleast the drug?
Drug. Yeah, that's an interesting
question. I think he used them as a
negotiating tool and from that perspective, not an overall
economic perspective, but in terms of medications, they work
for him. And it's basically kept your
prices the same your. Prices, the people that he's
negotiated with are the brand medications and we don't have a
(32:52):
whole lot of access to them. But what I will add that it's
possible now using what we've learned with our manufacturing
in Dallas, we're able now to take that plus AI we created so
that we literally are able to manufacture all those generics
we buy from India. We can manufacture them less
expensively in Dallas, TX, except we have one issue.
(33:15):
That one issue is there's something called ANDA, which
when you want to manufacture a new generic, you have to go to
the FDA who has to approve your factory and they charge $365,000
for each drug. And so even though we're able to
move. Generics.
Even generics, right? And so we want to manufacture
1000 of them, that's $365 million, which destroys the
(33:37):
economic. So if we're able to get a
waiver, so if anybody from administration is watching, if
we're able to get a waiver, we'll be able to move the
manufacturing of those thousand generics to Dallas, TX and have
it up and running within 18 months.
Wouldn't that fit President Trump's onshoring effort to
ensure that, I mean, if we had another pandemic, we don't have
to worry about getting, you know, generic drugs from a. 100%
(33:59):
not only that, we put the whole thing to be able to manufacture
the pills, generic pills into a tractor trailer.
So if there is an environmental disaster or someone we can make
them and ship them to. So we're in the parking lot of
of and we've taken that same technology to keep on pulling
the string so that we can manufacture north of one
(34:20):
medication. Have you talked to RFK about
this? No, but I've talked to the
people that work directly for him and so they're aware of it
and you know, in a couple cases they're really supporting us.
And so I'm not going to criticize of other than the FDA
fees, but we've created and my partner Alex Ashmanski is just a
rocket scientist genius. And so we're able to take that
(34:41):
technology, expanded some with AI and some other things, and
we're able to manufacture north of 1 medications.
So when you hear all these heartbreaking stories about
people who have a disease, whereyour child has a disease and
there's only 12 people in the world, typically what happens?
The researchers get, you know, money that's been raised and
they start working on solutions.But when they need to turn that
into an actual medication, they have to hire these companies
(35:03):
that will charge a half $1,000,000 and take at least six
months with there are are pods that we've created.
We can cut that down to $50,000 and do it within three months.
And and that's getting faster and faster.
And because in Europe they have these laws where I think it's if
two doctors agree that this is aunique, a unique drug and
(35:26):
solution to a specific rare problem, then we can manufacture
for them. So we're hoping we can get the
same thing done in the United States.
So all these people, all these parents that are raising money
for their child because they have this rare disease and they
can't afford to even create the OR know path we'll be able to
solve that problem. And we're starting, you know, we
have a first child from Italy that we're trying to work this
(35:50):
all out for. So when you talk about, you
know, government intervention and can we compete, Yes, we can
absolutely compete. We can absolutely change
healthcare. We can absolutely change the
economics of healthcare, but we're going to have to fight all
these huge insurance companies and can we do it?
Yes, we've done it so far and they're copying us rather than
(36:11):
vice versa. But the more help we get, the
faster we can go. One of the things I admire so
much about you, you're you're clearly a problem solver.
You want to fix things, but you also have a servant's heart.
And, and you, you care about this country and you care about
solving problems. In 2024, you can you campaigned
with Vice President Kamala Harris, who you endorsed.
But having now had a chance to reflect on this, and I just, I
(36:34):
know that, you know, Democrats from across the country are
coming to you saying, what should Democrats be doing
differently? What are Democrats going to be
getting wrong? You have said Democrats can't
sell anything. I mean, here you are selling an
idea, selling reform, selling healthcare, selling cheaper drug
prices. What are Democrats getting
wrong, though? Like, what can they learn from
you? Like what?
How do you assess? Yeah, you have to be a problem
(36:56):
solver first. Democrats used to be a party of
entrepreneurs. They no longer are.
You know, it used to be people that were part of the party were
focused on solving the problem as opposed to creating policy
first, because policy, creating policy in this environment
particularly is all about getting elected first as opposed
to solving problems. And I think they've got it
(37:17):
backwards. I think you have to solve
problems, which demonstrates to voters that you're able to solve
problems and that they support people who can't.
Think Kamala wasn't able to do that?
She, Kamala wasn't that. She wasn't able to do that.
She wasn't given the opportunityright to, to pitch any of that.
They couldn't. Democrats If you gave the
Democrats a chance to sell dollar bills for $0.50, they
(37:40):
would try to pass a law that made it happen before just doing
it. One of the things you've pointed
out, you've pointed to Donald Trump, Zoran Mandani, James
Talarico, the the candidate who's running for Senate in
Texas as as individuals who can leverage the attention economy
effectively. Yes.
Is that what any candidate needsto be able to do?
Absolutely. I mean, that's, that's what
you're doing. Yeah, I mean, other than
(38:01):
everybody watching Firing Line and with Margaret Hoover, I mean
people, particularly younger people, get most of their
information from their social media feeds.
Well, and that's what I see you putting Twitter, you know, X ING
out, tweeting out, you know, andyou're you're name checking
Laura Bloomer AOC all in the same tweet because you're trying
to pull people together on this on this idea of healthcare.
(38:24):
So to be a successful Democrat in the next wave.
I mean, I know they're asking you for advice.
Are you telling them yes, you have to win at this attention?
Game, yes, you have to understand that in an
algorithmic world where people get almost all of their
information via social media, even older people, right?
I mean, they're on Facebook all day long.
Everybody has their own individual feed.
(38:45):
If you want to know what a person's all about, look at what
their Instagram or TikTok or Facebook feed is.
And if you don't flood the zone,to quote Steve Bannon, right, if
you don't flood the zone and do things that gain the attention
of the algorithm and have it feed people, you're, you're
forgotten, you're lost. Look at when Donald Trump was
(39:06):
saying they're eating cats and dogs.
It wasn't because he thought people were literally eating
cats and dogs. He knew he was smart enough to
know. That's how you get attention in
an algorithmic world. Mandami here in New York, right?
He's Trump Junior. He's a little clone of Trump.
You know, James Talarico and Mandami, you know what they have
in common now? They both grew up in an era
(39:27):
where Donald Trump was the dominant politician that was
dominated by social media. And you look in Mandami
brilliant at social media, right?
I told the Democrats they shouldhire his team, pay him $10
million each to take them from him because that'll get them
further along than buying $50 million worth of ads on linear
media. OK, You've said 100 times you
(39:48):
are not going to run for president, correct?
Unless, yeah, Donald Trump runs for a third term.
Yeah, which I don't think you really believe he's going to do.
But he joked about it in the State of the Union this week.
That should have been his third term.
Right, right, right. I mean, is that, is that your
way of saying there's no way youreally ever run?
True, yes. So you and are you Democrat or
Republican now I'm. Independent, I think for myself.
(40:10):
So you'd never consider an independent because there's it's
you looked for an independent run at, you looked at an
independent run for president in2020.
No, I considered it, Yeah, just because people were asking me
about it and I thought it was flat.
Well, they. Haven't stopped asking.
No, I mean, I see polls all the time and people send me that.
There's a lot of private pollingthat suggests that you would be
the best candidate for the Democratic Party.
Yeah, I don't know that I'd wantto run as a Democrat.
(40:32):
I mean, I think would be more fun to run as a Republican just
to try to turn things upside down.
But I think I, I, you know, I, Ithink I would have a chance, a
puncher's chance, but I think I'd have the best chance by
being an independent. And the reason for that is
people are sick of the Republicans.
People are sick of the Democrats.
We're, we're sick of everybody just taking their own side and
(40:54):
just being divided as a country.And I think by saying as an
independent, yeah, I agree, the Republicans suck and the
Democrats suck. Let's bring people together and
focus on solving problems. Because by definition, anything
that an independent president does would have to be
bipartisan. It's so inspirational, but I
know you looked at it. Did you ultimately decide that
an independent, it's just so difficult mechanically in the
(41:17):
country for an independent to win because I think it's thrown
to the House of Representatives and.
No, I talked to my family and they all voted against it.
That was 100%. Who has the true veto in the
Cuban House? The whole family, not me, that's
for sure. Well, kids will be older in a
little while. Mark Cuban, thank you for
joining me on FIRING LINE. Thanks for what you're trying to
do to have. Margaret, it was a lot of fun.
Thank you. Thanks.
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