Mark Cuban’s Cost-Plus Pharmacy (Cost-Plus) has garnered significant attention for its transparent pricing model and potential to reduce prescription medication costs. Many self-funded employers are particularly interested in partnering with Cost-Plus, hoping it will yield substantial savings for their health plans. However, it’s crucial to understand that “cost plus” is not synonymous with “lowest cost.” Cost-Plus may source some medications below market prices, but there are instances where its prices are more expensive than other available sources.
Cost-Plus’s commitment to 100% transparent pricing is the primary value its model delivers and is in stark contrast to the opaque pricing practices of mail-order pharmacies owned by large Pharmacy Benefit Managers (PBMs) that often inflate costs to maximize profits. However, outside of the traditional marketplace dominated by the three largest PBMs (Express, CVS Caremark and OptumRX), transparency is a standard business practice. By engaging a transparent pass-through PBM employers can eliminate the need for add-on programs like Cost-Plus that attempt to counter some of the adverse practices of a broken system.
Employers should also understand the narrow scope of Cost-Plus. The program’s intent is to focus solely on transparent and fair pricing, with no emphasis on clinical pharmacy services, leaving an inherent gap in their approach. Acquiring medication at a fair price is meaningless if that medication is inappropriate for the patient or not taken correctly. Adverse drug reactions are a leading cause of death in the United States. Effective clinical management ensures that medications are used appropriately. This minimizes the risk of adverse reactions and maximizes their therapeutic benefits.
Prescription drugs are not just benefits cost to be managed. In many cases they are an investment in the ongoing management of a chronic disease and protection against a catastrophic, and much more expensive condition. This investment includes the patient’s commitment to being an active participant in the management of their condition, which can be compromised by adverse drug reactions or poor medication adherence. Employers should seize the opportunity to influence modifiable risks within their health plans to achieve the desired clinical outcomes, ensuring that medications provide their full value.
In summary, while Cost-Plus can improve upon some problematic aspects of the pharmacy industry—particularly the overpriced and poor service from pharmacies owned by PBMs—it is not a comprehensive program designed to address more than a few flaws in the system. The Cost-Plus model does not guarantee the lowest prices, and the absence of meaningful clinical management could undermine potential savings. A few percent saved on drug costs cannot compare to the value derived from comprehensive clinical pharmacy care, which can significantly enhance patient outcomes. As a pharmacy consultant, pharmacy owner, and clinician, I have a unique perspective on this issue. I’ve witnessed firsthand the profound impact that excellent pharmacy care can have on patient outcomes. Our focus must shift from viewing pharmacies merely as a fulfillment service to recognizing them as integral sources of patient care.
If you would like to learn more, or have comments or questions on this issue:
Please get in touch!
Contact Chris Antypas, PharmD
Director of Pharmacy Solutions
Phone: 412-261-1842 x 237
Email: [email protected]
