Mark Cuban and Healthcare Competition

Payton Herres successfully underwent heart transplantation surgery as a preteen. A year later, she began taking everolimus—a vital medication used to prevent her body from rejecting the transplant. Her insurance provider soon after denied coverage, leaving her with an indispensable but largely unaffordable prescription.  

Herres’ situation was alarming, but not uncommon. About 30% of Americans find themselves with uncovered treatment despite having health insurance. Unfortunately, medications for rare and/or chronic conditions, in some cases, have no generic alternatives. Not covering expensive but seldom-utilized treatments is an easy way for health insurance providers to cut costs. Unfortunately, these decisions can leave unsuspecting and financially strapped policyholders with few options. 

This is when Mark Cuban stepped in.  

Mark Cuban Cost Plus Drugs, an online pharmacy, helps many people in these situations access affordable medications, even without health insurance. Once unaffordable, his pharmacy now supplies Herres with a 90-day supply for about $300. In comparison, she likely faced bills ranging from $400 to $13,000 per month elsewhere.  

Cuban’s efforts are laudable, and in this case, probably lifesaving. And thankfully for many other patients, other efforts have been just as successful.  

Diabetic patients who need insulin can also face insurance gaps limiting access to life-prolonging medication. Like everolimus, insulin can be alarmingly expensive without coverage. Yet despite political promises and actions to make insulin more affordable, competition has quietly delivered for decades. Perhaps the most recognized example is ReliOn, which is available for about $25 a vial at Walmart pharmacies across the country. In some states, ReliOn is available over the counter.

During the nearly two-year GLP-1 shortage, many patients hoping to treat severe and complex forms of obesity were left without regular access to Ozempic, Mounjaro, and other injectable weight loss treatment options. Fortunately, copycat pharmacies and telehealth providers worked to help patients access generic-like treatments, even as insurance coverage struggled to keep pace with challenging market conditions. In this case, online pharmacies were so effective that they forced brand-name GLP-1 treatments like Zepbound to half their prices during a national shortage. Prior to the copycat and telehealth competition, some patients found themselves facing $1,000 prescription drug costs.  

These and other examples highlight a vital- but often overlooked- lesson about competition. The US healthcare industry is extremely regulated, particularly pharmaceuticals. And despite literal decades of political promises to expand coverage and lower prices, we’ve yet to see reform provide solid and consistent examples of either. Conversely, a relatively small online pharmacy and other unexpected retailers were able to provide what a larger health insurance provider and a torrent of regulations did not or could not- affordable medication. 

Sometimes a small dose of the right treatment is all you need.