An online pharmacy selling prescription drugs at a transparent markup — 15% plus a $3 pharmacy labor charge and $5 shipping — directly to consumers with no insurance accepted.

Cost Plus Drugs launched in January 2022 selling generic drugs directly, negotiating wholesale prices with manufacturers and sidestepping pharmacy benefit managers — no insurance claims, since insurers rarely work with pharmacies that avoid PBMs.

Experts told CNBC the model's limit was brand-name drugs, which accounted for nearly 80% of 2018 prescription drug spending: drugmakers have no incentive to give rebates to a pharmacy that can't offer formulary placement. Cuban said brand-name drugs were coming 'within six months', that some manufacturers had already started working with Cost Plus, and that the company would soon manufacture its own generics in a 22,000-square-foot Dallas factory set to open at the end of 2022.

The Dallas factory converts a reseller into a manufacturer — the only position from which to keep prices falling when competitors match the markup.

Declining insurance entirely is the brand: the pharmacy serves the uninsured, underinsured and high-deductible patients the rebate economy leaves behind.

The brand-name bet defines the ceiling of the venture: without it, Cost Plus cheapens the 80% of spending that matters least.

Transparency attacks the margin; manufacturing attacks the structure. To beat a middleman economy you eventually have to own the part of the chain the middlemen control.

As of the July 28, 2022 report, the factory was slated to open by year-end and brand-name plans were forming without public detail. The material records no launch results; a later entry covers the company's September-December 2022 employer-channel partnerships.

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  1. Mark Cuban's pharmacy startup is actually making drugs less expensive. It's still working on solving the real problem cnbc.com