Show the cost. Skip the theater.
Mark.
Mark Cuban and Alex Oshmyansky did not wait for a national list. They posted what they paid for a generic, added 15%, a pharmacist fee, and shipping, and mailed the bottle. The Mark Cuban Cost Plus Drug Company is a public-benefit corporation: manufacture, wholesale, pharmacy, a pass-through pharmacy benefit. His X account is the megaphone. Below: other firms chipping at the same framework from a different product.
The formula · The clout · The hoops · 1. Nobody granted him the molecule · 2. Become a licensed wholesaler — years, not a tweet · 3. Rent the fifty-state pharmacy on day one · 4. A doctor still has to write it · 5. Making the vial is a different mountain · Could anyone · Why not a website · Why not Walgreens · Two lists · The dogs · What he planted · On X · A cash-pay flagship hospital · Cost-plus imaging · Cost-plus labs · Cost-plus infusion chairs · Cost-plus implants and durable medical equipment · Un-TPA — pay the posted menu · Bill of materials for a stay · Cost-plus dialysis · Posted-price birth · The night
The formula is not a pharmacy trick.Show what you paid. Add a fixed markup, not a market-price. Sell to the person who actually writes the check — cash patient or self-funded employer. Skip the rebate, the group-purchasing-organization skim, the pharmacy-benefit-manager (PBM) loan dressed up as a discount. Publish the list so a researcher, a chief financial officer, or a Senate staffer can compare. That is Cost Plus Drugs. The rest of American care still hides the same spread on a different SKU.
costplusdrugs.com · @mcuban · The 15% math · Generics vs brands · The hoops · The plant
His name opened the door. It did not buy a secret generic.If you cold-call a factory tomorrow they will tell you no. That is true. The no is a license, a warehouse, and — on brands — a pharmacy-benefit-manager threat. It is not Shark Tank getting Teva to cut a celebrity wholesale.
Sourced: 38 of 40, and still no on brands
The cheap bottle
Generics already wanted the order
Alex Oshmyansky, the chief executive who started Cost Plus: direct deals with 38 of the 40 largest generic manufacturers. As a wholesaler they often pay those factories more than the big three distributors, so the maker is not in a race to the bottom. The $500 sticker was the specialty-pharmacy and rebate list, not a factory that only answers to a billionaire. Independent cash shops already buy the same tablet from Cardinal. They just do not have his megaphone.
The famous still hear no
Brands told Cuban no too
He cannot buy Ozempic. He has said the manufacturer will not sell through Cost Plus. A brand chief told him they would not deal until Cost Plus covered half the lives the big three pharmacy benefit managers cover. They floated a walk-in-off-the-street price, then they could not. That is formulary punishment: post the net and we demote your whole portfolio. Clout did not punch that lock. He is the clout. They still said no.
If you try the same thing
What they will tell you
No, because you are not a licensed wholesaler. Fifty-state pharmacy, Drug Enforcement Administration, working capital, a pharmacist on the hook. After that, commodity generics will sell. Brands will still say no — the same no they give him. You will not get his mouth, his employer meetings, or a free launch on every morning show. Copy the posted markup and a first customer, not the private jet. Volume later trims acquisition; that is ordinary wholesale, and their own site says they pass it through. The hoops he actually jumped are next.
How he got the right to the drugs
He did not. He got a wholesale license, rented a pharmacy that already had the fifty-state hoop, and waited for a real prescription. Cuban: more than three years of requirements. Sourced: the licenses and Truepill.
Not a patent. Not a franchise.
1Nobody granted him the molecule
There is no federal ‘right to the drugs.’ A factory owns the National Drug Code. It may sell to an authorized trading partner: a licensed wholesaler, another manufacturer, or a pharmacy. Cuban did not receive a special Food and Drug Administration waiver. He joined the same chain every McKesson truck is on. The Drug Supply Chain Security Act is the pedigree: you only buy from, and sell to, licensed partners. A website is not a partner.
Home state, then the map.
2Become a licensed wholesaler — years, not a tweet
Cuban to NBC 5: they spent more than three years going through the requirements. Oshmyansky founded the public-benefit corporation in 2018; the Cuban name went on in 2020; the shop opened January 2022. Home license in Texas as a wholesale prescription-drug distributor, then licenses in the states you ship into — later, they said all fifty. Inspection, a designated person who can pass a background check, a building that is not a spare bedroom. That is the hoop that lets a factory take the purchase order.
He did not fill the bottle himself.
3Rent the fifty-state pharmacy on day one
Oshmyansky to WFAA: we sell to Truepill. They are licensed in every state as a mail-order pharmacy. They pass on our price plus a pharmacist fee and use our branding. National Association of Boards of Pharmacy digital-pharmacy accreditation sat on Truepill, not on Cost Plus. January 2022 press: Truepill powered the site and the box. June 2023 they added HealthDyne when volume broke the first partner. Their own site now says URAC — Utilization Review Accreditation Commission — Mail and Specialty accredited facilities. The 50-state dispensing hoop was rented. That rental is Truepill’s product. Other digital shops buy it every year.
Not a candy counter.
4A doctor still has to write it
A valid prescription from a licensed prescriber. Cost Plus does not invent the script. The pharmacist on the partner license checks it. Controlled substances add a Drug Enforcement Administration registration. Launch was mostly ordinary generics. The hoop is boring on purpose. That is how you stay out of prison.
Not required for the mailbox.
5Making the vial is a different mountain
The Dallas sterile fill is Food and Drug Administration manufacturing: a plant, robotics, shortage injectables. That is years and millions after the wholesale license. You do not need it to buy albendazole from a generic maker and mail it. He built it later so a shortage could not hold the crash cart hostage. Do not start here.
Could anyone have done that?The path is public. A radiologist in Denver was already jumping it when he sent the cold pitch. Independent cash pharmacies jump a smaller version every morning. What is not public is a Senate grant of the bottle. What is not optional is the license. Anyone with capital, a designated pharmacist or wholesaler, a building that will pass inspection, and a mail-order partner can stand in the same line at the factory. They will wait three years. They will not get his mouth. Brands will still say no. That is the honest split: the hoop is a license, the megaphone is Cuban, the lock on Ozempic is the pharmacy benefit manager — not a secret right he was handed.
The three years · What they will tell you · Why pharmacies did not post it · The plant
They are not dumb. They already had websites.CVS.com ships. Walgreens.com ships. Amazon bought PillPack. GoodRx is a website of cash coupons on top of their counters. The missing product was not HTML. It was a public list that does not torch the insured book. Cost Plus could post acquisition plus 15% because the consumer shop launched cash — no Caremark contract sitting on the same register. That is the cheat code, not a smarter webmaster.
Usual and customary · Why not Walgreens · Team Cuban card
Not a coding problem
The website already existed. It was the wrong list.
Chain mail-order is the pharmacy-benefit-manager’s own box: Express Scripts, CVS Caremark mail, Optum. Those sites exist to keep the rebate and the steer. They will never print factory cost plus 15%. An independent already has a site for hours and refills. Putting albendazole at $35 on the homepage is a different act. That number becomes the shop’s usual and customary charge — the cash price the contract says you must submit on every claim.
Post it, get paid it
Usual and customary is the tripwire
Pharmacy-benefit-manager contracts pay the lesser of the contracted rate and the pharmacy’s usual and customary. Drop the cash price on a website, and the administrator can pay that same low number on the insured fill too. The Thriving Pharmacist’s version: you keep the official cash sticker high so the occasional ‘winner’ offsets the underwater generic. Relentless Health Value’s version: lesser-of is why you need a GoodRx coupon instead of a posted menu. They are not hiding HTML. They are protecting the book that is 80% of the register.
2018 gag-clause bills
Congress let them whisper. Not post.
The Patient Right to Know Drug Prices Act and the Know the Lowest Price Act banned gag clauses: a pharmacist may tell you cash is cheaper than the copay. They are not required to. They still cannot hang a Cost Plus menu without the usual-and-customary hit. Direct and indirect remuneration clawbacks still arrive weeks later. The National Community Pharmacists Association has been counting roughly a closure a day. That is not a shop that forgot to hire a developer.
A side door, not the homepage
The Team Cuban card is the website they could survive
Affiliate pharmacies fill at a posted cost-plus and a $12 dispensing fee, buying through Marketplace, off the clawback machine. That is the honest independent move: a second BIN, not a public chargemaster of every tablet they still bill to Caremark. Cost Plus could be the website because it was a new register. The corner shop is not dumb. It is captured. The chains are next: they had the site, the warehouses, and still could not hang the list.
Walgreens had Walgreens.com. That was never the problem.A chain is the usual-and-customary tripwire with a thousand doors. Post factory-plus-15% once, and every pharmacy-benefit-manager claim, Medicare fill, and Medicaid lesser-of at every store can fall to that number. They did not skip HTML. They would have been lighting the insured book on fire — the book they cannot fire, because they are not Cost Plus. They are the counter Caremark still needs in the preferred network.
The $100 million club · Usual and customary
Cash price and insured price. If insured is higher, oh well.That is the move. The contract forbids it. Usual and customary is not a courtesy sticker for the uninsured. It is the ceiling on the claim. The pharmacy-benefit-manager pays the lesser of the contracted rate and what you charge a person who pays cash. You do not collect $80 from Caremark and $35 from the card for the same tablet. You get $35 twice — or you get dropped for submitting a cash price that is not your cash price. Federal Medicaid is the same lesser-of. ‘Oh well, the job plan overpays’ is not a setting you can flip. It is a breach, then a network termination, then a lawsuit that says the cheap number was the real usual and customary all along. Walgreens tried oh well with a club. They wrote a $100 million check. Cost Plus can post $35 because there is no $80 claim on that register.
The club that was two lists · Russo v. Walgreen · The dogs
They do not hate the cheap tablet. They hate the exit.The dog is the pharmacy benefit manager, often wearing the insurer’s collar — Caremark inside CVS, Express Scripts inside Cigna, Optum inside UnitedHealth Group. Two jobs. First they police the pharmacy: cash is the ceiling, no two lists, direct and indirect remuneration clawbacks, an audit that can drop you from the preferred network. A low usual and customary is a gift to that desk. They will pay $35 and call it a win. Second they police the counter. Gag clauses existed so the pharmacist could not tell you cash was cheaper than the copay. The 2018 bills killed the gag. They did not kill the desk. What they hate is a cash price you can walk to without them — Cost Plus, a club, a whisper — because then there is no rebate, no spread, no copay theater. They love cash as a weapon against the shop. They hate cash as a door around the plan. That is not the hospital’s 2–3× night. That is the vial.
The 2018 whisper · Problems / solutions · Drug voices
Walgreens
They tried a club, not a list — then paid for the gap
Walgreens already sold cheap generics through a Prescription Savings Club: a fee, then $5, $10, $15 for hundreds of 30-day generics. That is a cousin of Cost Plus, hiding behind a membership so the official cash sticker on the insured claim could stay high. Plaintiffs in Russo v. Walgreen said that club price was the real usual and customary and that insured people and plans overpaid. Walgreens denied it. November 2024: Reuters — they agreed to pay $100 million to settle. The club ended. That is why a Cost Plus homepage was not an option. Post the $5 and the administrator can pay $5. Keep two lists and you get the lawsuit they just wrote the check for.
Chain scale
One sticker, thousands of registers
An independent can whisper cash, run a coupon BIN, or join Team Cuban as a side door. Walgreens is a national usual-and-customary. Preferred Part D networks, commercial contracts, Medicaid lesser-of. They complain that pharmacy-benefit-manager reimbursement is often below acquisition — and they still cannot walk. Walk and they lose the volume. Post the honest cash menu and they lose the margin on the volume they kept. Cost Plus launched a new register with no Caremark book on it. Walgreens is the old register.
CVS / Caremark
CVS is the same trap with the PBM in the basement
CVS.com already ships. CVS also owns Caremark, one of the big three pharmacy benefit managers. Their Health Savings Pass was the same club idea: cheap generics for members, a higher usual and customary on the insured claim. Plaintiffs in Corcoran and related cases say CVS failed to report the pass price as usual and customary, including to Caremark. CVS denies it. A Cost Plus list on CVS.com would not only collapse retail reimbursement. It would print the net the rebate desk exists to hide. They will not do that. The website is not the missing piece. The desk is.
The move they skipped
They could have spun a cash mailbox. They did not.
The legal Cost Plus move for a chain is a separate cash-only mailer with its own usual and customary, like Truepill was a separate license. Separate register, posted math, no club fiction. Walgreens bet VillageMD and clinic hours instead. CVS doubled down on Caremark. Amazon bought PillPack and still plays insurance. The big pharmacies are not too stupid to post a price. They are the price the old contract needs.
What he already planted
Do not copy the logo. Copy the stack. Each arm is a middleman skipped. Sourced from the Cost Plus Drug Company site, not a pitch deck.
The counter
Mail-order pharmacy
Acquisition cost, plus 15%, plus a pharmacist fee, plus shipping. The math is on the product page. No insurance required. That is the door a person can walk without a job plan.
The rebate theater
UnPBM — pass-through for the shop that already pays
Employers and managed-care shops get the same posted number. No rebate, no offshore spread entity. Bolt onto a network or replace the PBM. Cuban’s line: the rebate is a loan against the sickest employees, not a gift to the chief executive officer.
Hospital purchasing
Cost Plus Marketplace
Injectables and hospital SKUs at a thin markup. Group purchasing organizations sit between the manufacturer and the tower, then the PBM tells the employer the rebate was passed through. Marketplace is the published alternative. Community Health Systems buying epinephrine at a posted cost-plus is the existence proof.
Shortage rent
Dallas sterile fill
A robotics plant for shortage injectables. When the bag is scarce the old chain prices to panic. Make the vial, sell it at the same markup, stop the crash-cart ransom.
The independent counter
Team Cuban card — last mile
A local pharmacy fills at cost-plus instead of the PBM spread. Mail order is not the whole country. The last independent shop is how you chip the chain without a Senate bill.
What he keeps posting
X is the hallway. The same lines show up in interviews. Nothing here is scraped from the feed; these are posts that journalism and his own interviews already locked in. The move is always: post the number, fire the black box, sell to the shop that already pays.
On X, and every interview after the launch
This has been the easiest industry I have ever disrupted. All it took was transparency and telling the truth.
The product is the public list, not a nicer PBM. Once the number is on the wall, Medicare, Medicaid, and a self-funded shop can see they were buying a story.
On X, quoting a cash CT that was a fifth of the hospital outpatient number
If you are self-insured, never let the plan bill you for out-of-network care. They take the lower cash price with the provider and charge you the higher one. Pay the provider. Compare the cash rate to the claim. It is insane.
The ‘negotiated’ rate is not the floor. Cash often is. That is the same move Cost Plus made on the vial, applied to a scan.
On X, August, the deductible post
If you cannot afford your deductible, you might be better off not buying the plan. The cash price they will finance is cheaper than what the job plan ‘negotiated.’ Find a doctor who will take your card.
A bronze deductible is a loan the hospital has to collect. Cuban: providers are subprime lenders. The design is the problem, not a cartoon insurer inventing the hospital’s 2–3×.
On X and to Eric Topol, Ground Truths, December 2024
I do not blame the pharmacy benefit managers. I blame the people who contract with them. The chief executive officer thinks the rebate is great. It is a loan against the sickest people in the shop.
Same as this site on the night: the plan is a pass-through. Fire the black box. Keep the claims. Set the formulary. Audit without the PBM’s auditor.
On X, and about his own companies
Direct-contract the hospital. A person with a credit card often beats what the biggest plan negotiated for the surgery or the MRI. I pay cash. Reinsurance above a cap. I take that risk.
Unbundle the easy button. The big carrier sells stop-loss, third-party administrator, PBM, and network as one bag. Pick each piece. That is how you chip the framework without a statute.
On X and LinkedIn, 2026 — hospital pharmacy versus the PBM
Who would you trust to set the corporate formulary — a big PBM, or your local hospital pharmacy and therapeutics committee?
The hospital team has to treat the miss. The PBM has to recover the rebate. A business that sells hospital-pharmacy formularies to employers is Cost Plus for the list, not the bottle.
On X and LinkedIn — why Cost Plus is still mostly generics
A brand chief said they could not sell to us until we covered half the lives the big three cover. They would lose formulary placement for offering us a walk-in price.
The ‘no way’ you would hear on a brand is the same no he hears. The factory is not protecting a Cuban discount. It is protecting the rebate list. Generics were never that lock.
Sourced posts · Direct contracts · Problems / solutions
Other businesses that chip the stack
First the cash-pay flagship — Cost Plus with beds. Then the SKUs around it. Start where a self-funded chief financial officer can name last year’s volume. Do not start with your own emergency department. The building is Flagship · The plant · Hostile world.
The Cost Plus of the tower
A cash-pay flagship hospital
DoOne sticker, a real building, birth to a small ICU. The full product is on Flagship. Cost Plus with beds. Do not start with your own emergency department. That shovel is The plant.
SkipA cash menu on the same campus as a United contract at 2–3×. That is Walgreens with beds — two lists, then the lawsuit or the secret book. Buying the downtown monopoly. A freestanding emergency department in a plaza.
Flagship — the building
Hospital outpatient scan
Cost-plus imaging
DoA national posted MRI and CT menu: machine minutes, radiologist, 15%. American College of Radiology sites only. The employer’s third-party administrator is forbidden to send a shoppable abdomen to the tower. Cuban already posted the punchline on X. Someone has to be the Cost Plus of the magnet.
SkipA ‘network’ that is still the hospital outpatient department with a coupon. A freestanding emergency department that bills imaging like a trauma bay.
Hospital outpatient draw
Cost-plus labs
DoMail-order and storefront blood at acquisition plus a fixed markup, the lab code on the wall. The draw is a commodity. The hospital outpatient lab is a second chargemaster. Same formula as the generic tablet.
SkipA ‘concierge’ panel that hides the wholesale. Quest with a nicer PDF is not the move.
340B and hospital-outpatient specialty
Cost-plus infusion chairs
DoBiosimilars and generics in a chair that posts average-sales-price plus a thin markup, not a hospital ambulatory payment. Cuban already undercut Humira-class product with Yusimry on the bottle. The chair is the other half of the 4×. Steal the site of care the way Cost Plus stole the mailbox.
SkipA 340B hospital ‘savings’ program that still bills the job plan near list. That is the old spread with a charity logo.
The device group purchasing organization
Cost-plus implants and durable medical equipment
DoKnees, hips, continuous glucose monitors, continuous positive airway pressure, ostomy, wheelchairs: show factory cost, plus 15%, plus a fitter. The implant is saline with a patent. Discharge DME is a second PBM. Post the SKU the way Surgery Center of Oklahoma posts the joint.
SkipA ‘preferred vendor’ that is still the hospital’s implant rep with a rebate.
The preferred-provider discount theater
Un-TPA — pay the posted menu
DoA third-party administrator that pays cash prices and Cost Plus numbers, owns the claims, and buys stop-loss on top. Employee Retirement Income Security Act fiduciary: you have to explain the choice. Johnson & Johnson and Wells Fargo already got sued for the black-box PBM. The medical side is the same loan. Cuban’s companies already do the cash-plus-reinsurance version.
SkipA new logo that is still UnitedHealth Group’s administrator with a wellness app. If you cannot fire the pharmacy benefit manager and the network separately, you bought the bag.
The opaque invoice
Bill of materials for a stay
DoCuban: almost no health system can hand you a bill of materials. A firm that itemizes every stay the way Cost Plus itemizes a vial — glove, minute, implant, vial, overhead — and posts the markup. Employers and counties buy the file. Researchers copy it. The chargemaster dies of sunlight.
SkipAnother machine-readable file dump the American Hospital Association already lost a lawsuit over. A file is not a menu. A menu is a number before the stay.
The DaVita / Fresenius door
Cost-plus dialysis
DoA posted session: nurse, machine, water, drugs at Cost Plus. The duopoly is a must-have three times a week — closer to the emergency department than a knee, but not a certificate-of-need trauma tower. A county or a union can fill chairs. Steal the chronic 5% that walks on a schedule.
SkipA ‘value-based’ joint venture with the duopoly. You become the rent.
The maternity chargemaster
Posted-price birth
DoA birth center or a small hospital that posts the uncomplicated delivery, the C-section, the neonatal night. Shoppable until it is not. Partner for the crash. This is The plant’s beds with a Cuban sticker on the wall.
SkipA boutique that dumps the emergency to the monopoly tower at 3×. Cheap and unsafe is not Japan.
Cost Plus chips the shoppable vial. It does not hang a must-have emergency-department sign. The 5% at 2 a.m. still meet a hospital that extracts 2–3× Medicare; the job plan passes it through. Cuban’s cash MRI is the steer. The cash-pay flagship is the door. Use both. A Cost Plus clone that never grows into beds is a nicer GoodRx. A flagship that takes the secret 3× and posts a cash menu is Walgreens with an ICU.
The plant · Flagship · Hostile world · Self-funded · Positioning · The 5% · Shop
The hallway: Flagship · The plant · Hostile world · Self-funded · Positioning · Direct care · Centers · Problems / solutions · Drug voices · Political action · Clout vs the factory · The hoops · Usual and customary · Walgreens club · Evidence