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Today on This Week Health.

There's no certainty, there's no transparency. And the pricing is out of whack and the institutions we trust to protect us, aren't protecting us. And in terms of payers and providers, their interests are aligned financially, but they're not aligned with the patient. And so that's a recipe for disaster for quite a few people.

Thanks for joining us on This Week Health Keynote. My name is Bill Russell. I'm a former CIO for a 16 hospital system 📍 and creator of This Week Health, a channel dedicated to keeping health IT staff current and engaged. Special thanks to our Keynote show sponsors Sirius Healthcare, VMware, Transcarent, Press Ganey, Semperis and Veritas for choosing to invest in our mission to develop the next generation of health 📍 leaders.

All right today, Mark Cuban, owner of the Mavericks, Shark Tank, TV personality and investor and most important for this interview, founder of the Mark Cuban Cost Plus Drug Company. Mark welcome to the show.

Thanks for having me on Bill. I mean, when I get a chance to do a interview with an infamous basketball player, I'm always going to take

Every time I go to Boston and I just go online, try to get a restaurant or whatnot. I'm really shocked at how amazing the tables are that I get in Boston and how disappointed people look when they, when they actually see.

The guy in Dallas named mark Cuban, who tells me I'm friends with them on Facebook. And he says, it's the same thing, man.

Hey, mark. this interview was really spurred by. I sat in the health conference a couple of years back and watched you essentially give people a everybody in the audience. So this is healthcare providers, insurance pharma, you name it, and you told them they needed a wake up call. I think the message was the patient is getting shortchanged by the system. Talk to us a little bit about how the patient's getting shortchanged.

Well, it's obvious. I mean, there's no certainty, there's no transparency. And the pricing is out of whack and the institutions we trust to protect us, aren't protecting us. And in terms of payers and providers, their interests are aligned financially, but they're not aligned with the patient. And so that's a recipe for disaster for quite a few people.

Yeah. the fact that there's no transparency, I went out onto your website and it's, it's fascinating because the drugs are all listed there. The price, the amount they're going to save are, are all listed there. I'm not, I'm not sure where else I would go in the industry to see that.

Yeah, it's tough. I mean, there's others who try to do it in various ways, but I think the difference with us is we deal directly with the manufacturers and we sell directly to the consumer. We use Truepill as our pharmacy, and there are no other intermediaries. There's no rebates There's no contracts, there's no insurance companies and our goal, we have one simple goal to be the lowest cost provider of drugs, period. End of story. You're not going to get bells and whistles. You're not going to get Teladoc to call in. You're not going to get a fancy t-shirt. If you buy X number of dollars worth none of.

I'm looking at some of these prices and this was noted in a, a PBS interview. I think that that maybe you did it talks about diabetes medication sells for $3 and 90 cents, a 30 day supply on on the online pharmacy, on your online pharmacy normally sells for 17 bucks. But the one that just caught my eye was. The leukemia and other cancers, medication, $17 and 10 cents versus $2,500. Are there specific diseases or clinical domains that the company is focusing on at this point?

No. And there's two parts there. One the ref a lot of people will give us our time. Well, that reference price or use the $2,500 people can get a cheaper and they can, the problem is you have to be a sleuth, an online detector and jump from pharmacy to pharmacy or intermediary to intermediary to find that price a lower price. And you don't know if it's going to be consistent from week to week or month to month, depending on the prescription you have, whereas with ours we, this is the same price all the time. Period. End of story. It's our cost plus 15% and part two to that. Is we're really going to be consistent and transparent. I mean, you're just going to get our cost plus 15.

Yeah. All right. So let's, let's get into the specifics. You start to hit on this a little bit. The company is set up as a, as a PBM. It's an online pharmacy and you are also a manufacturer of drugs. So the, the aim, if I'm reading a lot of these things correctly, the aim is to take out the middleman. What are other aspects of the business and how is it? How's it going to take out the.

Well first we're, we're not a pharmacy per se right now. We're not where you were partnered with tru pill. So they do all fulfillment. Right. And the way we take out the middleman is partly doing our own manufacturing. We're building a plant in Dallas and we've got some third-party relationships to manufacture for us, for drugs. We can't manufacture in Dallas and hopefully that'll be open by the end of the year. And then. Again, we'll deal directly with the manufacturers, for the things that we don't make.

And because we're our own PBM, we can set up direct relationships with unions, with self-insured companies, with hospitals a lot of people believe, and I'm not here to argue it. That PBMs are the organizations that historic pricing. And when PBMs become part of a vertically integrated organization, like an insurance company with pharmacists chain store pharmacies, then they get to what's the right word.

They get to control the price name in a lot of different ways. And then the, we even extend that they'll create entities overseas in the Caymans or wherever, and they'll do manufacturing there and they'll create a arbitrarily high retail price so that then they can discount it and sell it at a discounted price.

But they're still keeping all the marks. And rebating back to themselves where possible. So by being a PBM, that's transparent by being a retailer that is transparent. We eliminate all the uncertainty and I'll add this the pharmacy, I'm sorry, the manufacturers more often than not are not the bad.

And we're becoming their best friend because the PBMs act as the intermediary, they're the doorman at the fancy bar, collecting the cover charge, deciding who gets in and deciding also what alcohol is served at the restaurant and bar. And if you want to have your alcohol served, then you're going to have to not only negotiate a good.

But also set a very high retail price so they can look at you, make themselves look good in the discounts and then also pay a rebate in order to continue to sell into that restaurant. And so that's the way PBMs operate for the most part. And so the, the, the drug manufacturers are saying, look, we love what you're doing because we don't have to deal with any of that, those shenanigans we can just sell our product, you market a 15%.

And not only does cost plus drugs solve a problem, but now all of a sudden the manufacturers look really, really good because the price they're selling out, plus 15%, it looks dirt cheap. Like they're seeing on cost plus drugs and who else looks like a good person a good person out of. Now the drug manufacturers look like a good person.

Well, yeah, but it's it's over here and aren't, they also the insurance carrier, they go, yeah. And I'm sitting there going, wait a minute. This is.

And even worse. It's even worse than that. Because if you're not part of that PBMs, vertical integration at the pharmacy level, let's say you're in a an independent pharmacy. And you're you want your prices to show up where a lot of people are going. You may have to pay to get a popular prescription sent to your. You're not going to get paid a fulfillment fee. You're going to have to pay because the attitude is, well, if you pay that intermediary $10 per prescription or $10 per customer, you're going to make it up with them, buy an aspirin and OTC and toothpaste and toilet paper. And that's just insane.

All right. So we're going to get into a little bit more. In this, but when people are listening to this, they're like, isn't, isn't this civic RX, isn't this the same. And for those who don't know, a bunch of health systems went together and they essentially looked at generics that were being sold into. Primarily into the providers and they came up with civic RX. And for the most part, I think what they're trying to address is drug shortages that exists across the health systems right now.

You know, I didn't answer your question the first time in terms of what we choose. I space that and it, that applies to what civic RX is doing. We choose which drugs to offer by availability and impact. We really try to focus on equity, meaning drugs that are truly needed that people have a hard time affording. It may not. If we choose that drug is because it's available to us, we can save them a lot of money. We can get the inventory. It may not make us the most amount of money may not.

We're still just going to make 15% no matter what, but at the same time where there's shortages or where it's just difficult for somebody to get that drug like likely leukemia drug. We click that leukemia drug. Then we'll focus on that first. We're not looking for the highest rate the drug that's prescribed the most or that we could deliver the most.

We're looking to have the most equity impact. So that's how we choose. And relative to Civica RX, to your point, they're trying to get the hard to come by the shortest drugs, particularly for hospitals. Excuse me and that's their primary focus. So we talked to them all the time and we CA we think we compliment them.

So I know the answer to this question, but I'm going to, I'm going to sort of set you up with this. is this an equity problem? The cost of drugs?

It Absolutely. Is. I mean, if you don't have insurance, you're Sol. We all have heard the stories and they continue to pop up every single day. And it's criminal that they do that people have to make choices between rationing their drugs, paying their rent, choosing to eat, buying baby formula, whatever it may be.

And so this is an equity problem where not everybody has equal access to drugs. Not everybody has a great job with a great insurance program where they don't have to worry about it. worry about paying for the drugs and even some that do we try to be lower than the co-pays So that people might say, well, you're not going to fill up your deductible.

So in case something big happens, you're not going to be able to you'll have to pay for it. Well, even if you use up your deductible, as long as we're cheaper than the co-pay, you're still coming out ahead.

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All right. So talk to me about the health systems and the health providers. It sounds like you're in conversations with, health providers. how does your business model fit in with their business?

They want cheaper drugs, right. It makes their life easier. When when you look at the cost of healthcare in this country, one of the big things that stands out as a red flag is the administrative cost and a big underpinning of the administrative costs is each time a provider becomes part of a network. There's new contracts to be done. And each time they renew those contracts and there's new plans from the. Then there's additional administration costs associated with dealing with those. And then that increases the ability for the payer to deny or not pre-approved claims or to deny claims, which just makes things more complex for the provider.

By working with us, we simplify that and we minimize the administrivia and the administration costs. So it's cheaper, easier for the provider and cheaper, easier for the patient as well.

And from a provider standpoint, you, you will take e-prescribing through Surescripts. Is that, so I'm looking at your website here. E-prescribing through Surescripts. Oh, a patient cannot pay with insurance at this time. It is a, it's a cash model, is that accurate?

Yes. And that's, we're not going to change that because the payer system, the insurance system is so back ass, half words that, like I said, it adds significantly to the cost of healthcare care in this country. And if you look at Medicare and medical loss ratios it's 85%, 15% of a bigger number. Is more profits. And so there's no direct incentive for the insurance companies to push down. Their rates are pushed down their revenues, which means it's okay if hospitals to providers charge more.

And so, and the games they play, that's why, when you look at a charge master, it's insane, some of these prices. And then now with the law passed a couple of years ago Where they have to post on their website and let's hope that they Jack up the fines and penalties for not posting the pricing on your website, but when you do, when, when providers do post on their website, there's different prices for different insurance programs and a dramatically different in typically lower price per cash pricing. That's. That is absolutely insane. And so we won't work with insurance companies unless they change how they do business.

All right. So I crowdsourced some questions ahead of this. And essentially what I did is I sent it to a bunch of people who work in healthcare and said, all right, good. Give me some ideas of what I should ask mark Cuban. I took out the eight or nine basketball questions. You'll you'll handle those in another venue. A lot of them had to do with the flow of information, right? So are you, when prescriptions are filled through you, is that information flowing back? And I think the answer to that is yes. If you're using Sure Scripts And you fell and you're using this partner. This partner is probably connected in a way that gives.

That traditional pharmacy and they review everything

Adverse drug. they're worried about adverse drug effects, but for the most part, you're dealing with generic. So that information is already in the EHR. They're going to pick that up.

So you hope that the doctor who prescribes it has already done that, but we do have a Two pills that reviews and pharmacists there that review everything. But obviously one of the challenges is if a patient splits their prescriptions among different sources, because they're searching for the lowest price, then that can create an issue.

But you hope the doctor deals with that, but more importantly, or just as importantly we've got a hundred plus drugs. Now we hope to have that well past a thousand, by the end.

No, it's interesting because a lot of them, so let me just read this one, because I think it's interesting. He's up against giant companies with lots of money and influence and complicated relationships with tentacles wrapped around through government manufacturers, insurance companies, drug stores, pharmacists, retailers, and more, there's all kinds of super complicated contract arrangements that include rebates and hardwired incentives that keep this giant self-licking ice cream cone stuck together. The participants in this cartel, mostly like the deals they have and they make good money on it. And the system is built to keep others out. How is mark going to break in or break out?

So first this didn't just happen overnight. Our farmer pharmacy launched on January 19th. and We've got hundreds of thousands of customers already. But this we've been doing this and working on this for more than three and a half years. And so it took a lot of time to build trust. So when we went to manufacturers, it wasn't like, oh, okay. Well let's ignore our biggest customers. Our biggest distributors our biggest insurance companies that we work with.

It took time for us to explain the model, show them, demonstrate to them how we were going to do it. Let them see it when we started to put together and let them see the initial response. Once we launched on January 19th, it was a culmination of all those things to build trust. And then the second part, all those in sensuous, incestuous relationships, we just avoided them.

We didn't deal. If you don't want to deal with us, great. Don't deal with us. You that's why we started with generics because there's typically more than one manufacturer or we have the opportunity to manufacture ourselves. And so that created an opportunity there.

Mark, when you were going back and forth with Trump and all that, that stuff some people thought you were conservative. Some people thought you were liberal. And I think I saw you say it once. And it's what I've told people. I'm like, he's a capitalist. That's he's, he's a capitalist. That's, that's why he's in this. If you're a capitalist and this is why you're in this the end of the billionaire giving back, or is it more, there, there is an opportunity for good capitalism here to change the way this functions.

Capitalism is creating businesses for rewards and the rewards don't always have to be about maximizing or cash profits. There's all kinds of rewards that we all give from doing things every single day. And so trying to use the capital that I have, and I'm financially blessed. I am thankful every single day, but I'm a hardcore capitalist and I get to pick the rewards I want for my capital and the rewards I want for this is not to make more money, but I want to disrupt an industry cause that's very, very rewarding to me.

Disrupt the industry. That's interesting because. the response I I'm walking around amongst people after the, the health interview that happened and the general consensus was another billionaire who's going to solve the healthcare conundrum. Right. Bezos, buffet Jamie diamond had Haven, Oracle just bought Cerner. So you have that kind of aspect. How do you avoid that fate?

We're not trying to fit in. That's what they tried to do. All of them. Cigar equities and trying to fit in. We're not trying to fit in and it's not about how much money I have in my wallet. It's really just our approach and the fact that we're not having to go out and raise money.

And so there are a lot of steps to get from there to here. And if we hadn't had success in at least some of those steps along the way, We wouldn't have been able to launch cost plus drugs.com, but we have, and it's it's started off with the bank. I mean the proof is in the results for the customers, the patients.

it's amazing to me, how much you know about healthcare. I mean, it's, is this recent knowledge over the last couple of years?

I've been working, I've paid for studies it all started when the, the Republicans were trying to blow up the ACA and I was like, and I talked to some of the people in their administration. I'm like, so what are you going to replace? And then we're like, we don't know my, well, let me start to think about that. And so I started to come up with a Cambo, something to call it a 10 plan, and then COVID came along and that kind of dice that, but along the way, I've paid for studies comparing the cost of healthcare in Toronto to New York.

Because when you think about. The costs in New York and Toronto real estate is more expensive in Toronto. The cost of doctors and nurses are the same. The cost of band-aids are the same there's differences because Toronto the province of Ontario will pay for malpractice insurance and they'll cover all bills.

So there's, there's a, a cost concept there that advantages, Canada, but everything else is the same. So why is, are, is Toronto? Why are Toronto hospitals able to charge less than what Medicare pricing is. And when you go back and read the Medpack reports, you see they're using benchmarks that were created in 83 and 93. I think it was. And they and I've even talked to some of the folks there and they they just work from those, those benchmarks and that's how they figure out pricing, which makes no sense at all. And then when you start to try to figure out the costs that hospitals have for procedures or anything that.

The hospitals don't know, I wanted to pay for a study that went around and asked all the different hospitals, how they do their cost accounting. No one would respond.

Yeah. Cause they don't do it. I mean, I had the CFO for UPMC on and he talked about this. He goes, health systems do not know their costs. They do not have a good cost accounting. It really is. I don't know of any other business that runs this way, where you don't know the true cost of what it is.

I went to an event at the university of Pennsylvania on healthcare, and I just asked one of the CEOs of their healthcare system there. I'm like everybody says they lose eight to 9% on Medicare. How do you know. Right. Where does that come from? Do you lose money? When a Medicare patient comes in with a broken arm, or you try to tell me you lose money on the prices you charge. And he said, no, we probably make money. So, which is it and who challenges them to even know? I talked to another hospital and they were talking about the mental health program that they wanted me to support.

And the first thing they said was they built a building. I said, well, the first thing you do is you sell that motherfucking building and use that money for your patients. And it's a great program. I mean, it's going to help a ton of people, but don't need new buildings and it, you see how CEOs in healthcare are compensated. And a lot of them are really, really good, but you need more revenues to make more money.

Well, how do you, how do you, so from an entrepreneur standpoint, I feel like I'm the one sitting on shark tank right now saying, okay. I don't understand your business model cause I'm looking at it. going don't you need to have a relationship with someone, either the, either the providers, the pharmacists, I mean isn't there. Someone you need to have a relationship with?

Yes Absolutely. The patients there are so many patients that are struggling and stressed and you know what patients who are stressed do? They talk online to other patients who are. stressed And they tell them, well, I was paying $700 for this medication. Now I'm getting it for $83 on costplusdrugs.com I was paying for some patients it's I was paying $14. Now I'm paying $4 Or I was paying $8. Now I'm paying $6. And for somebody who is living paycheck to paycheck, or may not have a paycheck going from $8 to $6 a month. Makes a difference. And so those patients are our greatest advocates.

And so if you go on Twitter and do a search for cost plus drugs or cost plus drugs.com, you're going to see post after post them on Facebook of people just saying, thank God. I don't have to make these decisions that I used to have to make. And, oh my God, I didn't have insurance and I'd go to the pharmacy and they would tell me this price and I didn't know it better.

And then someone come in and say, well, check this company and check this company. And now people are coming in and. No check cost-plus drugs.com if they have it. And there's obviously a lot we don't have, but hopefully we'll, but if we, if cost-plus drugs.com has it, then you're going to save money. And that's the only relationship we need.

Because if you're broke and your life depends on your medication, you are looking for every resource you can. And as long as we make those people, as long as we reduce the stress of those people, as much as we legitimately can. And keep that consistent. So it's not like some of these places that one day you got to go to this Walgreens the next day you got to go the next fill.

You got to go to that CVS on the other part of town and we're just keeping it consistent. And on top of that, as our prices go down cost, plus 15 goes down. And so each of the last two weeks we've lowered prices on four drugs each week. And we'll continue to do that on at least.

So, so is that why you become a PBM so that you can actually negotiate with other manufacturers and do that?

Yeah, not only manufacturers, but healthcare systems, providers unions, self-insured companies. So like we'll fulfill the generics for the mavericks.

Yeah, that makes sense. But actually having this conversation reminds me of the conversation I had with Glen Tullman from Transcarent. Because it's, it's similar, right. It's looking at it and going aspects of this needs to be blown up. I mean when we were talking he started talking about the fact that businesses just keep paying more and more and more and more. And it's, it's a system where all these companies over here are making more money, but it's, it just funnels down and it's, it's killing entrepreneurs.

The prices aren't helping anybody, but the PBMS or the providers or those vertically integrated companies and what's happening now, bill is the, the self insurers. And particularly unions are going to the manufacturers and say, saying you're not on our formulary with this insurer that we're working with, or this network we're working with, sign up with cost plus drugs, and we'll do a deal with cost plus drugs. Just give us your best possible price. And now you're in.

During the pandemic, telehealth went through the roof and then it came back down. And one of the studies showed that the number one indicator of if people were going to use telehealth was the physician telling them the next meeting we're going to have is telehealth.

So the physicians still play significant role and probably in, in this aspect as well, if they tell them. Hey, go to CVS and pick this up because you know what happens is I go in and they ask me when I get there, what's your preferred pharmacy. And I put that in there and then it gets prescribed and I just go down there and pick it up

and that's going to happen. And we're going to educate physicians. Look, we've only been up and running since January 19th. And so what you see is just the first inning or the first preseason. I guess baseball analogies. Aren't great right now. It's just it's just the first three minutes of the first game in the basketball priests, the NBA pre-season.

Right. And so we're just starting and we don't expect for every physician to know who we are. But again, when that patient talks to the physician and said, says, you know what, I've already checked the pricing on cost plus drugs.com. Can you send a prescription to them? What's the, what's the physician going to. Nine out of 10 times, they'll say, okay, what's the pricing and can I use it for my other patients? And that's what's happening.

Yeah, absolutely. Mark, any, any, anything else you want to say about this? Cause I have two questions outside of cost plus drugs that I just have to ask you .

Yeah. And if the cost plus plus drugs.com, there's a four providers link up there. Answered a lot of questions. The medications thing just, just astounds me. It's all right there. And at the bottom of.

If you're looking at the price, cause there may be a situation where we pay a little bit more and maybe we are a little bit more it's rare, but you know, maybe because we're working with a manufacturer isn't ready to give us their best price yet. And they want to see how much volume we create. So there might be one or two things out of the a hundred plus that you may be able to find a lower price somewhere, but I assure you that that price is going to go down. And so over time, we'll be adding more drugs as our costs go down, we're going to push the pricing down.

We're going to not only have generics, as I said, but we'll also have brand names.

Fantastic. All right. three questions to end this. One's about billionaires. One's about baseball. I'm a huge baseball fan. So and the the final, one's really going to be about how we got this interview set up. Cause I, I just have questions as to how this happened. First question billionaires, who's going to win the space race. Is it, Musk, Bezos Branson? Is it, is it India? China?

I have no idea, but I think it comes down to Bezos or Musk because they're both tech guys and they're both ego-driven and they want it. They also want to do the right thing. people like condemn them for doing this, but it's a hedge against our stupidity when it comes to protecting our environment. And so I'm, I'm glad they're doing it, even though they're getting a lot of grief.

Yeah. Yeah. I mean it, to be honest with you living down here in Florida, every time one of those one of the launches happens people are excited. I mean, it's, fun to watch now. All right, let me, let me ask you about baseball and it's not a great time to talk about baseball, but you're, you're owner of a sports franchise. It's really calm. The economics of this is isn't as complex as what they're making it sound or is it, is it just you have two sides?

Well, what I can tell you is transparency helps. Cause transparency builds trust and on both sides. Because the sources of income for players are different than than they were 20 years ago. And same for teams, no matter what the sport. And so I don't know their details, but I do know from our experiences that trust and transparency have a big impact.

So it's just, it's sitting down, everyone seeing what's going on on either side it's.

You should, you really should be partners in this. And that's what this is all about in the NBA. I mean our, our collective bargaining agreement is public. Anybody can go online and read it. The players get 51% of our revenue. And so it's a part of.

Interesting. All right. We set up this interview with an email that I sent to your inbox. first of all, I was surprised that you responded, second of all, it's public. First of all, why do you do that? And how do you do that? Most people can't get through their inbox on a, on a daily basis, but you seem to be doing an awful lot of things and able to respond to that email.

And so I can, I can do a search in all. So it's not like, okay, what was I talking to bill about when it came to healthcare in that first email. And so I can just search, I can search bill Russell and it shows me all those emails 10 years now. And so that's why I prefer to do things via email.

And in terms of my email being public, you never know where great ideas are coming from. There's, there's a company talking about space. It's called relativity space and they make 3d printers for space rockets. And Tim Ellis is a local Dallas guy sent me an email. I invested now it's been millions of dollars. I've still not met.

That's a, that's amazing. Mark. Hey, I, appreciate what you're doing. I do believe it is an equity issue and I hope we can get the word out there. I hope doctors start taking a look at the medications that are available online. And get, get behind, really driving down the cost of the medications.

We know this is one of the biggest problems facing individuals, bankruptcies due to healthcare, continue to be one of the most horrific stories out there. So I wish you the best of luck. If I can help in any way, let me know.

Well to everybody watching sister industry, my email is mcuban@gmail. And so feel free if you're having any questions you'd like to work with cost-plus drugs.com. Just reach out and let me know and we'll see if there's a way we can work together.

Sounds good. Thanks again for your time. Really appreciate it. Thank you for everything.

What a great discussion. If you know someone that might benefit from a channel like this, from these kinds of discussions, go ahead and forward them a note. I know if I were a CIO today, I would have every one of my team members listening to a show like this one. It's conference level value every week. They can subscribe on our website thisweekhealth.com or wherever you listen to podcasts. Apple, Google, Overcast, everywhere. Go ahead. Subscribe today. Send a note to someone and have them subscribe as well. We want to thank our Keynote sponsors who are investing in our mission to develop the next generation of health leaders. Those are Sirius Healthcare. VMware, 📍 Transcarent, Press Ganey, Semperis and Veritas. Thanks for listening. That's all for now.