“They come to us because our cash price is often lower than what their insurance plan asks them to pay,” Cuban told Texas House lawmakers on Sept. 1. “That tells you something is wrong.”

The billionaire Cost Plus Drugs cofounder and former Shark Tank star used the hearing to prescribe five steps to fix America’s healthcare affordability crisis, which has left a record 51% of U.S. adults unable to reliably afford quality care, according to West Health-Gallup. Many of his remedies share a common active ingredient: transparency.

Mark Cuban’s 5-step plan to fix healthcare costs

• Let insured patients choose the cheapest option—without penalty. If a prescription costs $500 through insurance but $100 through Cost Plus Drugs, patients should be able to take the cheaper route and have that spending count toward their deductibles and out-of-pocket maximums. “Patients should be rewarded for saving themselves and their health plan money. They shouldn’t be punished for it,” Cuban said. “That’s how you create something healthcare desperately needs: price competition.”
• Standardize contracts for drug middlemen. Cuban wants standardized contracts for pharmacy benefit managers (PBMs) and third-party administrators. Three PBMs—CVS Caremark, Cigna’s Express Scripts, and UnitedHealth’s OptumRx—handle roughly 80% of U.S. drug claims. Their contracts can run hundreds of pages, making harmful terms easy to bury. “I call it contractual terrorism,” Cuban said. He has drafted a model PBM contract that states, cities, counties, and school districts could use as a template. “Just stop making every government entity negotiate these contracts from scratch,” he said. “It’s a losing game for everybody.”
• Make pricing public wherever taxpayers foot the bill. Any taxpayer-funded program, including Medicare and Medicaid, should be required to disclose pricing data such as rebates, fees, guarantees, and affiliate compensation. Without that “price discovery,” Cuban argued, a market can’t function efficiently when one party holds all the information.
• Eliminate gag clauses. These provisions keep employers and plan sponsors from openly discussing their contract terms, which Cuban said blocks them from comparing fees and negotiating better deals.
• Give enforcement real teeth. Regulators could go easy on a first significant violation, Cuban said, but should hit repeat offenders with much steeper penalties. Under the current system, he said, “some of these companies can make billions, get caught, pay a fine,” and “write it off more easily than I wrote off my NBA fines.” He added: “That’s not deterrence. That’s a cost of doing business for them.”

Cuban’s unlikely allies in Washington

Cuban’s crusade on drug prices has made for strange bedfellows. In May, TrumpRx, the White House-backed discount drug site, added more than 600 generic medications through Cost Plus Drugs, alongside Amazon Pharmacy and GoodRx. The deal put Cuban on the same side as President Donald Trump, who called him “a loser” during the 2024 campaign.

Cuban also threw his support in March behind the Break Up Big Medicine Act from another odd couple: Sens. Josh Hawley (R-Mo.) and Elizabeth Warren (D-Mass.). The bill would bar a single company from owning both an insurer or PBM and medical providers. It has been referred to the Senate Judiciary Committee and hasn’t advanced, but Cuban has kept pressing the case, recently arguing that rising healthcare costs, not AI, are the real threat to American jobs.