Mark Cuban Urges Breaking Up PBMs, Empowering Employers
In a Nov. 5 conversation at Becker's CEO + CFO Roundtable, Mark Cuban, co-founder of Mark Cuban Cost Plus Drug Co., said the three largest PBMs (Express Scripts, CVS Caremark and Optum Rx) handle 80% of U.S. prescription claims and should be broken up, citing the Break Up Big Medicine Act introduced by Sens. Elizabeth Warren and Josh Hawley, which he has publicly backed. He said UnitedHealth Group has 3,000 subsidiaries and conducts $150 billion in intercompany transfers annually. Absent a breakup, Cuban said self-insured employers, who per a KFF survey covered 63% of workers in 2024, could drive change by scrutinizing their contracts with third-party administrators. He also discussed Eli Lilly's and Novo Nordisk's direct-to-patient GLP-1 sales as a way to bypass PBM rebates, and said Cost Plus Drugs, launched in January 2022, is setting daily sales records and now supplies roughly 300 hospitals through its wholesale arm.