Mark Cuban has spent more than four years building something the healthcare industry is still figuring out how to respond to.
What started as a mail-order pharmacy selling generic drugs at transparent prices has grown into a vertically integrated operation spanning manufacturing, wholesale distribution, retail pharmacy, direct contracting and federal drug policy. Each added layer has been designed to add volume, drive down costs and cut out the big intermediaries that Mr. Cuban argues has made U.S. drug pricing indefensible.
“I came in as an entrepreneur and said, let’s just look at this as like I would any Shark Tank company. And really, what it comes down to is just following the information flow and money flow,” he said at Becker’s Chief Pharmacy Officer Summit in April. “Our ultimate product isn’t drugs, it’s trust. Trust equals transparency, divided by self interest.”
1. Drug supply (Cost Plus Drug Co.)
The foundation of Mr. Cuban’s healthcare push is Cost Plus Drug Company, the online pharmacy he co-founded with Alex Oshmyansky, MD, PhD, on a straightforward premise: Sell medications at manufacturing cost, plus a 15% markup and flat fees, cutting out traditional pharmacy benefit managers and wholesalers entirely.
The idea emerged from Mr. Cuban’s own experience as an employer, where his former NBA franchise, the Dallas Mavericks, had been overpaying for employee prescriptions.
Cost Plus Drugs launched with a few dozen generics and scaled quickly, reaching 2 million customer accounts within its first 13 months. By early 2024, the catalog had crossed 2,000 medications, and by January 2025, it had surpassed 6,000, spanning generics, branded drugs and biosimilars.
To anchor the supply side, Cost Plus built an $11 million, 22,000-square-foot manufacturing facility in Dallas that began producing sterile injectables in shortage in 2024, starting with epinephrine and norepinephrine in vial sizes common in hospitals. The plant can currently produce between 1 million and 2 million doses annually but is designed to scale to 70 million. Mr. Cuban said the facility has since expanded to produce Pitocin, pediatric cancer drugs and sterile water, and that generic tablets produced there are cheaper than those sourced from India.
The branded side of the portfolio has grown in parallel. Recent additions include Xofluza, Yaz and Climara, along with the company’s most high-profile branded deal to date: Eliquis, one of the most widely prescribed oral anticoagulants in the U.S., which Bristol Myers Squibb and Pfizer began offering through the platform in April at $345 for a 30-day supply.
2. Hospital wholesale (Cost Plus Drugs Marketplace)
While Cost Plus Drugs started as a consumer-facing pharmacy, the company opened a second front in early 2024 with the launch of its “Marketplace,” a standalone wholesale business supplying medications to hospitals, surgery centers, clinics, long-term care facilities and retail pharmacies across all 50 states. The division stocks more than 4,000 medications, with a focus on injectables that frequently fall into shortage.
The first health system to sign on was Franklin, Tenn.-based Community Health Systems. The partnership began in March 2024 with shipments of epinephrine and norepinephrine to nine CHS hospitals — a deal that came together after months of late-night exchanges between CHS leaders and Dr. Oshmyansky about utilization trends and supply pain points. CHS executives described the relationship as fundamentally different from a typical vendor arrangement;
Heather Weese, PharmD, vice president of pharmacy services for the health system, told Becker’s that Dr. Oshmyansky’s willingness to engage directly on manufacturing questions and active pharmaceutical ingredients set it apart.
By June 2024, CHS had expanded the agreement to all 71 of its hospitals, starting with 12 generics and projecting savings of several hundred thousand dollars. Louisville, Ky.-basedScionHealth followed as the second system partner in May 2024, spanning 94 hospitals. Tacoma, Wash.-based MultiCare has said it saved $1.1 million in seven months on 125 generics, and Philadelphia-based Penn Medicine also began procuring through the platform.
In March 2026, Cost Plus Drugs partnered with GraphiteRx to embed its pricing inside existing hospital procurement workflows, giving pharmacy teams a side-by-side comparison against traditional wholesalers without changing their purchasing systems.
Still, Mr. Cuban has been candid that the economics have not been enough to overcome institutional inertia everywhere. At the Becker’s pharmacy summit, he said the biggest barrier to Marketplace growth is not price, but convincing procurement departments to step outside the GPO contracts they’ve traditionally used.
3. Pharmacy network (Team Cuban Card)
The consumer side of Cost Plus Drugs extends beyond the mail-order website through an affiliate pharmacy network that allows customers to use the company’s pricing at physical pharmacy locations. Mr. Cuban pitched the concept to independent pharmacy owners in early 2023, with the collaboration centered around the “Team Cuban Card,” which functions like an insurance card at the checkout counter. He told Becker’s at the time that the move was part of a larger movement to prevent more local pharmacy closures:
“Unfortunately, [independent pharmacies are] not in the small communities like they used to be just because they can’t afford to stay open,” he said. “But if we lose them, then the PBMs control everything.”
The network launched with 36 pharmacies and expanded quickly as major grocery chains signed on. By late 2025, the Team Cuban Card was live at more than 17,000 pharmacies across the country, including locations at Albertsons, Publix, Kroger, Food Lion and Jewel Osco.
4. PBM partnerships (pass-through model)
Before launching the affiliate pharmacy network, Cost Plus had initially explored creating its own pharmacy benefit manager. After scrapping those plans, the company turned to partnerships, teaming up first with the PBM Rightway in 2022. The same year, Cost Plus added EmsanaRx as its second partner, launching a product called EmsanaRx Plus, which was described as a supplemental drug discount product designed specifically for employers that integrates with existing employer-sponsored drug benefits so members can access lower-cost medications without going outside their health plan. RxPreferred Benefits followed in January 2023 as the third partner.
“It’s turned out to be much more efficient to partner with transparently minded and innovative PBMs like Rightway,” Cost Plus Drugs founder and CEO Alex Oshmyansky, MD, PhD, told Becker’s in 2022. “Why build all that infrastructure ourselves when there are good actors in the space who already have done it for us?”
By mid-2025, the company had more than 25 partnerships with pass-through PBMs, with the collaborations aimed at helping plan sponsors lower drug spending and aligning incentives with stakeholders. All contracts are published publicly, mirroring the transparency model that Cost Plus applies to its drug pricing.
The broader market impact of Cost Plus’s approach has drawn notice from legacy players. By early 2024, major PBMs including Express Scripts and CVS Caremark had announced their own cost-plus-style transparent pricing models, with Walgreens’ CEO telling investors that the market had evolved to create pressure to provide “the Cost Plus experience.”
5. Health plan partnerships
As Cost Plus Drugs has grown, a handful of payers have integrated the company’s offerings directly into member benefits.
Capital Blue Cross, a Harrisburg, Pa.-based insurer, became the first health plan in the country to partner with Cost Plus Drugs in early 2023, allowing its roughly 1 million members to use their insurance cards on the platform and apply prescription costs toward their deductible if eligible. The relationship expanded in April, with the insurer adding coverage of two Cost Plus biosimilars (Humira and Stelara alternatives) for its commercial members.
In early 2025, Network Health, the insurance arm of Wisconsin-based Froedtert ThedaCare Health, integrated Cost Plus Drugs into its Medicare Advantage pharmacy network. The insurer built a fully electronic claims integration with its PBM, Express Scripts, processing prescriptions in real time with no paper claims and purchases counting toward members’ Part D accumulators.
In April, Humana announced that its CenterWell Pharmacy unit will integrate Cost Plus Drugs’ SwiftyRx digital platform to process prescriptions and develop new employer-sponsored prescription solutions, with CenterWell serving as a distributor for the program. The partnership will also extend to eligible Humana employees.
6. Direct contracting (Cost Plus Wellness)
Mr. Cuban’s most recent initiative extends the transparency model beyond drugs and into how hospitals and providers get paid. Cost Plus Wellness, which he detailed at the pharmacy summit, is a direct contracting platform that connects self-insured employers with healthcare providers through publicly posted contracts — no intermediaries, no spread pricing, no balance billing, no prior authorization requirements and no hidden administrative fees.
Mr. Cuban has described the platform as an “open-source project” rather than a business. All contracts carry 30-day payment terms, and insurers are explicitly barred from using any of them.
The platform currently lists 27 published contracts covering at least 9,200 providers and 193 facilities, most of them concentrated in the Dallas-Fort Worth area, with Mr. Cuban saying more will be added across the country. Dallas-based Baylor Scott & White Health was among the first major systems to sign on. Cost Plus Wellness distinguishes between contracts it has directly negotiated and “community contracts” that providers self-publish using the platform’s template.
The pitch to hospitals rests on a financial argument that Mr. Cuban has pressed repeatedly: Once denials, clawbacks, late payments and administrative costs are fully loaded in, the largest commercial payer relationships may turn out to be the least profitable. He urged hospital leaders to run a profitability-by-carrier analysis and then sit down with the large self-insured employers whose workers they already serve. Mr. Cuban said the earliest adopters of Cost Plus Wellness have been small and midsize self-insured employers.
7. Manufacturing innovation (modular pods)
Cost Plus Drugs is now taking its Dallas manufacturing model and shrinking it into tractor-trailer-size modular pods that can produce sterile injectables virtually anywhere.
Mr. Cuban discussed the concept at the pharmacy summit, framing it as the company’s most consequential long-term play. The pods can be deployed to hospital campuses, disaster zones or research facilities and can switch between drugs in approximately four hours. Rare disease therapies that have historically cost upward of $500,000 and taken six months to produce, he said, could now cost roughly $50,000 and potentially take less time.
Mr. Cuban said FDA Commissioner Martin Makary, MD, has been enthusiastic about the concept, and that as robotics and AI continue to improve manufacturing efficiency, drug production costs will keep falling.
“That, literally, over the long term, is going to be our biggest business and will save the most lives and money,” Mr. Cuban said.
8. Federal partnerships
Alongside its private-sector expansion, Cost Plus Drugs has aligned with two federal initiatives aimed at broadening access to affordable medications and strengthening domestic drug production.
TrumpRx: The Trump administration announced TrumpRx in September 2025 as a federal direct-to-consumer website connecting patients with prescription drugs at discounted “most-favored-nation” prices. The site launched in February 2026 with 43 drugs and has since expanded past 50, with major manufacturers including Pfizer, AstraZeneca, Eli Lilly and Novo Nordisk participating.
Cost Plus Drugs feeds daily pricing updates to TrumpRx, which functions as a referral hub rather than a direct seller. Mr. Cuban has been publicly supportive of the initiative while noting that some drugs listed on TrumpRx are already available as cheaper generics through Cost Plus.
Equip-A-Pharma: In May 2025, Cost Plus Drugs was among four partners selected for Equip-A-Pharma, a White House initiative to bolster on-site drug manufacturing in the U.S. Under the program, Cost Plus is deploying an AI-enabled automated platform to produce active pharmaceutical ingredients, including lidocaine and diltiazem, which ties directly into the company’s broader manufacturing ambitions.
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