Mark Cuban, a prominent business leader and founder of Cost Plus Drugs, has criticized pharmacy benefit managers (PBMs) for profiting from inflated list prices rather than reducing costs for patients. He said that this practice drives up drug prices and limits access to medications. His remarks were made in a public speech posted on X.
"PBMs actually prefer higher prices," said Cuban. "They auction off access to their formularies to the highest bidders. Patients are getting ripped off because PBMs and wholesalers insist on using inflated list prices instead of transparent net prices. Fix that, and we finally put patients, not PBMs, back at the centre of American healthcare."
Pharmacy benefit managers play a crucial role in managing prescription drug benefits for approximately 270 million Americans. They control which drugs are covered and at what price through complex rebate and fee structures. According to a 2025 Federal Trade Commission report, the six largest PBMs process about 90% of all prescription claims in the United States, granting them significant influence over drug pricing and pharmacy networks.
The three largest PBMs—CVS Caremark, Express Scripts, and OptumRx—dominate the U.S. market by controlling nearly 80% of all prescription drug claims. Their concentrated power allows them to determine medication coverage, influence pricing structures, and negotiate rebates that affect patient access and costs across the healthcare system.
A 2023 analysis from the Markkula Center for Applied Ethics at Santa Clara University found that PBMs often engage in "pay-for-play" arrangements. In these deals, drug manufacturers pay for favorable formulary placement. These rebate-driven agreements can exclude lower-cost drugs, inflate list prices, and shift higher expenses onto patients instead of improving affordability.
Cuban is an American businessman known as the founder of the Mark Cuban Cost Plus Drug Company, launched in 2022 to enhance transparency and affordability in prescription drug pricing. The company sells generic medications at cost plus a 15% margin and pharmacy fee, aiming to bypass traditional PBMs and reduce patient expenses.
