Mark Cuban has set out a five-step plan to cut healthcare costs in the US, arguing that greater transparency and tougher enforcement are needed after insured patients told a Texas hearing they could pay less by buying medicines in cash.
The Cost Plus Drugs co-founder told Texas House lawmakers on September 1 that some customers were using his pharmacy despite having insurance because its prices were lower than their plans’ charges.
“They come to us because our cash price is often lower than what their insurance plan asks them to pay,” Cuban said. “That tells you something is wrong.”
His proposals come as 51% of US adults are unable to reliably afford quality healthcare, according to West Health-Gallup. Cuban said the measures would introduce more effective price competition into a system he believes is difficult for patients and public bodies to navigate.
Cuban’s five steps to lower healthcare costs
First, Cuban said patients should be allowed to choose the cheapest way to obtain a prescription without being penalised by their insurance. If a medicine cost 500 dollars through an insurance plan but 100 dollars through Cost Plus Drugs, he argued that the cash payment should still count towards the patient’s deductible and out-of-pocket maximum.
“Patients should be rewarded for saving themselves and their health plan money. They shouldn’t be punished for it,” he said.
He also called for standard contracts governing pharmacy benefit managers, or PBMs, and third-party administrators. CVS Caremark, Cigna’s Express Scripts and UnitedHealth’s OptumRx handle roughly 80% of US drug claims, while contracts can run to hundreds of pages.
Cuban said he had prepared a model PBM contract that could be adopted by states, cities, counties and school districts, rather than forcing each public body to negotiate from scratch. He described the existing arrangements as “contractual terrorism”.
His third proposal was to require public disclosure of pricing wherever taxpayers fund a healthcare programme, including Medicare and Medicaid. That would include rebates, fees, guarantees and payments to affiliated companies.
Without such information, Cuban said, there could be no proper “price discovery” and the market would not work efficiently when one side held most of the information.
He further urged lawmakers to remove gag clauses that prevent employers and plan sponsors from discussing the terms of their contracts. In his view, those restrictions stop organisations comparing fees and negotiating better deals.
Finally, Cuban called for stronger penalties for repeat offenders. He said regulators could show leniency after a first serious breach, but warned that some companies could currently make billions, pay a fine when caught and treat the penalty as a business expense.
“That’s not deterrence. That’s a cost of doing business for them,” he said.
Cuban finds allies in Washington
The campaign has placed Cuban alongside political figures with whom he has previously clashed. In May, TrumpRx, a White House-backed discount drug website, added more than 600 generic medicines through Cost Plus Drugs, alongside Amazon Pharmacy and GoodRx.
The agreement put Cuban on the same side as President Donald Trump, who called him “a loser” during the 2024 election campaign.
In March, Cuban also backed the Break Up Big Medicine Act, introduced by Republican Senator Josh Hawley and Democratic Senator Elizabeth Warren. The bill would prevent a single company owning both an insurer or PBM and medical providers.
The legislation has been referred to the Senate Judiciary Committee but has not advanced. Cuban has continued to argue that rising healthcare costs, rather than artificial intelligence, pose the greater threat to American jobs.
