So PBMs accept<\/a> rebates from pharmaceutical companies and use other strategies that reduce spending (in theory) without necessarily reducing the price of individual drugs. Pharmacies, in turn, contract with multiple PBMs.<\/p>\nThe price offered by PBMs can vary \u2014 day to day, sometimes. That\u2019s why organizations like GoodRx (which aggregates prices across several outlets) and some independent pharmacies (which can acquire medications from wholesalers looking for higher volume) can opportunistically offer better prices on selected generics. It\u2019s also why significantly lowering total drug spend is difficult.<\/p>\n
Other large companies are trying other cost-lowering strategies. Amazon, for example, has launched a subscription service for members of its Prime club that provides for unlimited access to 53 generic medications. There\u2019s substantial overlap between Amazon\u2019s and Cuban\u2019s list. If Amazon\u2019s clout worries Cuban, he\u2019s not saying so. \u201cI won\u2019t speak on the record about competitors,\u201d he told KHN.<\/p>\n
It\u2019s common for large retailers \u2014 like Walmart \u2014 to offer low, fixed prices for many generics. There are also startups, like one called Renee, that offer subscription services for generics.<\/p>\n
Cuban\u2019s company occupies an unusual niche in the market. It\u2019s not a pharmacy \u2014 it relies on Truepill, a digital mail-order company, for those services. It\u2019s also not a PBM \u2014 though it has partnered with a few.<\/p>\n
Cost Plus Drugs has started the process of building its own factory for generics, but right now critics wonder whether it\u2019s really changing the supply chain. \u201cThey do not accomplish their mission of eliminating the middlemen as they do not yet manufacture anything and do not operate their own pharmacy, i.e., they are only middlemen,\u201d concluded Kyle McCormick, who runs an independent pharmacy that also offers cash prices based on a similar markup over the cost of the drugs.<\/p>\n
\u201cIt frustrates me that they claim to be innovating when all they are currently doing is doing things slightly better than incumbents,\u201d he said.<\/p>\n
Cuban often demonizes his competitors, GoodRx CEO Doug Hirsch said. \u201cHe’s a TV personality and he does a great job at bottling the anger that consumers have,\u201d he said, before conceding he was glad Cuban was in the market.<\/p>\n
Indeed, the media blitz is a critical ingredient in the company\u2019s success so far. Cuban has said his company doesn\u2019t spend money on marketing. Some credit the size of his Twitter following (nearly 9 million accounts) or his ability to earn news coverage. Cuban credits word-of-mouth.<\/p>\n
Although patients\u2019 comments on social media are generally favorable, there are exceptions \u2014 and revealing ones. Elisabeth Bitros, a Generation X nurse\u2019s aide from New Jersey, said she switched antidepressants to Cost Plus Drugs after her brick-and-mortar pharmacy tried to charge her hundreds of dollars. But Cuban\u2019s company wasn\u2019t perfect either, she said. A glitch delayed the refills for her antidepressant around the 2022 holiday season.<\/p>\n
\u201cThis medication, you start to withdraw if you miss a dose,\u201d she said. \u201cI don’t want to go through the holidays withdrawing!\u201d But getting customer service from Cost Plus Drugs was challenging: It was hard to get hold of someone by phone. \u201cIt was all done electronically,\u201d she said. After a few days of tag-teaming the service with her doctor, she went back to CVS.<\/p>\n
Cuban declined to comment on Bitros\u2019 case specifically on the record, but wrote: \u201cWe try to be very transparent about the fact that while we have operators that are available and we are always looking for exceptions that need personal attention and improving our support, we won’t be the fastest or highest touch source.\u201d<\/p>\n
Cuban concluded: \u201cThat’s just a reality that comes with being the low-cost provider.\u201d<\/p>\n