Episode Overview

Podcast: Bulwark Takes
Episode: Why Is Mark Cuban Working To Cut Drug Prices?
Date: December 30, 2025
Host: Jonathan Cohn (The Bulwark)
Guest: Mark Cuban (entrepreneur, investor, and founder of CostPlusDrugs.com)

Main Theme:
This episode explores Mark Cuban’s motivations and methods for disrupting the prescription drug market in America through his company, CostPlusDrugs.com. The conversation delves into why the U.S. pays more for healthcare and drugs than other countries, how price opacity and middlemen drive costs up, and what realistic reforms might look like. Cuban discusses transparency, the role of pharmacy benefit managers (PBMs), his vision for broader health system reforms, and his outlook on political and regulatory barriers.

Key Discussion Points and Insights

1. Why Mark Cuban Entered Healthcare (03:17–04:46)

• Cuban’s Motivation:
  Cuban was approached by Dr. Alex Osmiansky about starting a compounding pharmacy for drugs in short supply (e.g., pediatric cancer meds). Cuban was shocked at how easily manufacturers could manipulate and spike prices due to market shortages and lack of oversight.

  • Quote: “Is there any more hated industry than the economic side of healthcare?...Nobody dies healthy. We all go through it...It's not a big stretch. We figured out very quickly that people who can’t afford their medications...if they knew what the price was, then they would have better options.” — Mark Cuban (03:17–04:53)

• Transparency as the Root Problem:
  Cuban discovered that the lack of transparency in prescription drug pricing allowed for widespread abuse and price gouging.

2. The CostPlusDrugs Model (06:04–07:37)

• How It Works:
  CostPlusDrugs.com bypasses traditional drug pricing by listing medications at the actual cost plus a transparent 15% markup and shipping.

  • Example: Medications costing hundreds elsewhere sold for as little as ~$9 through the site.

• Addressing Specialty Drug Pricing:
  Specialty generics—like cancer drugs—were especially overpriced. Cuban’s company offers these for a fraction of the "market" price, highlighting patient stories to underline impact.

3. Why Was Cuban’s Approach Needed? (07:37–09:36)

• Market Incentives & Cuban’s Unique Position:

  • Cuban is quick to note: “Because I’m rich as fuck and I didn’t care about the money. ...If I were 25 or 35, I probably would have priced to market.” (07:44)
  • Most traditional businesses—beholden to shareholders or personal gain—don’t have the luxury or motive to upend pricing norms.

• Insurance Companies’ Limitations:
  He argues that insurers and employers, even large ones, lack the tools and incentive alignment for deep price negotiation and transparency.

4. The Role (and Failure) of Pharmacy Benefit Managers (PBMs) (09:36–13:18)

• PMBs as Middlemen:
  PBMs, initially expected to drive down costs for insurers, have become profit-seeking intermediaries who obscure pricing, keep rebates, and contribute to higher prices for patients and independent pharmacies alike.

  • Quote: “The greatest lie ever told by PBMs is that they get the best price for you.” (10:16)

• Double Dipping:
  PBMs can route much of the cost back to themselves as rebates, while underpaying pharmacies for prescriptions filled.

5. International Comparisons—The Role of Government (13:18–14:54)

• Other Countries’ Strategies:
  Other developed nations set drug prices or negotiate directly, often without PBMs. U.S. prices—after accounting for rebates and discounts—end up close to international prices, but only after a convoluted process.

• Can CostPlus Model Coexist with Reform?
  Cuban believes his model can work alongside government intervention, especially if regulations eliminate the PBM layer.

6. Imagining Systemic Health Care Reform (15:16–21:37)

• Cuban's Ideal Healthcare System:

  • Complete transparency.
  • Individuals pay what they can, government covers the rest.
  • Employers contribute a fixed (but lower than current) percent of income.
  • Remove ACA and employer-provided insurance; pool resources for broader coverage.
  • Allow premium providers (e.g., Mayo Clinic) to opt in or out.
  • Essential gatekeeper function: Require primary care referrer, “If we do that, then this becomes easy.” (17:21–19:06)
  • Quote: “Everybody gets the healthcare that they need at a price they can afford.” (15:47)

• Importance of Transparency:
  Cuban emphasizes that pricing transparency is foundational. Without it, budgeting and reform are impossible.

7. Differences with Foreign Healthcare Systems (21:37–24:03)

• Gatekeepers and Public Infrastructure:
  Overseas, primary care serves as entry-point and triage, and public beds/services are sized to meet transparent price controls—unlike the fragmented U.S. system.

• Luxury Providers:
  U.S. “boutique” hospitals like Mayo/Stanford would remain outside the public system, serving those able to pay.

8. Political Obstacles and Current Efforts in Washington (24:03–27:27)

• Congressional Paralysis:
  Cuban is sharply critical:

  • “Dumb as shit, right?...They don’t come up with solutions, they just game it.” (24:24)
  • Both parties, in his view, lack actionable reform, and existing expands (like the ACA) have been hollowed out.

• On Medicare for All:
  Cuban admires the ambition but argues the proposed legislation is full of impracticalities and vague concepts:

  • Quote: “Medicare for all as written by Jai, Paul and Bernie are concepts of a plan.” (27:27)

• Suggested Incremental Steps:
  Removing PBMs, paying independent providers promptly—these are actionable, if limited, reforms.

9. Trump, Healthcare, and Broader Political Comments (30:09–33:50)

• Trump on Healthcare:
  Cuban suggests Trump delegates to smart, detail-oriented people, but political sanitization prevents thorough reform.

• On Speaking Out vs. Focusing on Healthcare:
  Cuban deliberately avoids broader political fights to maintain his ability to make an impact on healthcare:

  • Quote: “The more I talk about the political side of it, the less impact I’m able to have on healthcare…and I truly believe that I can have an impact there.” (33:59)

• Cost Plus Expansion & AI-driven Manufacturing:
  Cuban describes new initiatives: building manufacturing capacity in Dallas using AI/robotics, and direct contracting with providers (Cost Plus Wellness), for even greater price transparency and bypassing insurance intermediaries.

10. Medicaid Cuts & The Road Forward (36:23–37:36)

• Medicaid Funding Cuts:
  Cuban calls recent Medicaid cuts “awful,” but believes all elements (PBMs, state programs, price transparency) are interconnected and require systemic overhaul.

Notable Quotes & Memorable Moments

• “Is there any more hated industry than the economic side of healthcare?”
  —Mark Cuban (03:17)

• “Because I’m rich as fuck and I didn’t care about the money. Honest guy, right? My next dollar is not going to change my life.”
  —Mark Cuban (07:44)

• “The greatest lie ever told by PBMs is that they get the best price for you.”
  —Mark Cuban (10:16)

• “Everybody gets the healthcare that they need at a price they can afford.”
  —Mark Cuban (15:47)

• “Dumb as shit, right? They don’t come up with solutions, they just game it to get the political benefit.”
  —Mark Cuban on Congress (24:24)

• “Medicare for all as written by Jai, Paul and Bernie are concepts of a plan.”
  —Mark Cuban (27:27)

• “The more I talk about the political side of it, the less impact I’m able to have on healthcare. And the thing about healthcare, it impacts everybody. Nobody dies healthy and nobody likes the economic side of healthcare like we have it today.”
  —Mark Cuban (33:59)

Timestamps for Important Segments

• Introduction & Cuban’s Motivation: 00:41–04:53
• CostPlusDrugs Explained: 06:04–07:37
• Market Incentives & Transparency: 07:37–09:36
• PBMs and Their Role: 09:36–13:18
• International Drug Pricing Comparison: 13:18–15:04
• Cuban’s Healthcare System Ideals: 15:16–21:37
• Foreign Healthcare Gatekeepers vs. U.S.: 21:37–24:03
• Politics & Congressional Paralysis: 24:03–27:27
• Trump and Healthcare Politics: 30:09–33:50
• Expanding CostPlus (AI & Wellness): 33:59–36:23
• Medicaid Funding Cuts: 36:23–37:36

Tone and Style

The conversation is candid, occasionally irreverent (Cuban doesn’t mince words), but ultimately hopeful about the potential for meaningful disruption and reform. Cuban is both pragmatic ("I can't win every battle") and optimistic about the positive impact transparency and technology can deliver to the health system.

This summary covers all major points, highlights the most important insights, and provides clear guidance for anyone wanting to understand why Mark Cuban is dedicating his resources to tackling one of America’s most persistent—and frustrating—problems.