When the billionaire entrepreneur Mark Cuban talks about what his Cost Plus Drugs company can do to reduce prescription costs, his message is simple.
In contrast, established pharmacy benefit management (PBM) companies and their health insurer owners say they have the ability to “treat the whole person” because of their large networks of pharmacy and doctor choices and an added ability to manage diseases thanks to vast databases of claims and patient health histories that they have.
So what was Cuban’s response at last week’s Forbes Healthcare Summit?
“I would say we’re treating the whole person plus their wallet,” Cuban told attendees at the 14th annual Forbes Healthcare Summit at NYU Langone Health in Manhattan. “And do you really want your PBM to be doing all your disease management and all that, or do you want to hire the best provider of that service?”
Simplicity, transparency and reducing hurdles are key parts to why Humana, one of the nation’s largest health insurers for older adults, is working on partnering with Cost Plus Drugs in a potentially unique arrangement between an established provider of health benefits to millions of Americans and a smaller disrupter co-funded by Cuban.
Cuban says Cost Plus Drugs is a “very simple business.”
“You go to costplusdrugs.com, you put in the name of the medication, if it’s one of the thousands … that we carry, it comes up [and] it shows you our actual cost, actually what we pay for,” Cuban said at the healthcare summit last week. “Then we show a 15% markup because we thought that was fair and then, because we’re primarily mail order, it’s $5 to ship it to you. And that’s it. And because of that, it’s simple, easy to understand and it’s dramatically cheaper, in most cases.”
At a time when health insurance costs are rising and could see record spikes next year thanks to a flood of new and popular drugs like GLP-1 prescriptions for obesity, Cuban and Humana’s CenterWell pharmacy business see an opportunity. Health insurers and pharmacy benefit management companies are also under fire for a lack of transparency in how they make money with many of them eliminating controversial rebates they are paid by drugmakers or working to scale them back to give their clients a bigger discount on prescription drugs.
“We are known as an insurance company, but if we’re going to deliver against consumer needs, we need to be in spots in the delivery system that can really impact the access, quality, and ultimately the cost of healthcare,” Rechtin said of Humana, a health insurer best known for providing Medicare Advantage plans to more than 5 million older adults.
“And that’s what CenterWell is all about,” Rechtin said of the pharmacy unit of Humana’s CenterWell health services business. “We basically looked at the traditional (pharmacy benefit) model and we said we are not getting the cost efficiency [and] the affordability that we need to make sure that our members are getting access to medications the way they need to get access to medications. So, we built a pharmacy to try to correct that, and then along the way, what we realized is we’ve actually got a pretty good asset here that is really good at getting medications from the manufacturer – from the plant – to the consumer quickly, efficiently and effectively. That’s good for healthcare [and] it’s good for cost.”
Cuban and Humana’s Rechtin say they want to make the model simpler and more transparent from the drug manufacturer to the patient.
“If you look at how the system operates end to end and you think about all the different players and all the different systems; we have the manufacturer, we have a hub, we have a PBM, we have a distributor, we have a pharmacy – and that doesn’t even name everybody that’s in the system, end to end,” Rechtin said. “The question is, how much value is being added in each of those at each of those steps? And then, how much does it cost? Do you really need all of that cost? And is it really all adding value?”
The initial effort for Humana and Cost Plus Drugs will be in the area of direct-to-employer programs that bypass traditional pharmacy benefit management companies. Though Humana is best known for its Medicare business, Rechtin is working to transform the health insurer into a consumer healthcare company.
Details of the partnership weren’t disclosed, and it’s and still in early stages but both executives acknowledged they see a great opportunity with employers who pick up a big tab for U.S. prescription costs, according to sources close to both companies.
But Cuban and Humana’s CenterWell pharmacy business are working together because they see an opportunity with employers who are tired of paying more for prescription drugs with few alternatives.
“We need more CEOs of large employers to basically say ‘Hey, we’re going to demand a different model. One that is transparent, one that bypasses the system that’s been in place now for decades,’” Rechtin told the Forbes Healthcare Summit audience. “And look, there are alternatives, but those alternatives can’t be fully built without the demand that we need from employers, and that really is going to require CEOs to step into the benefit process.”
