If it weren’t for Martin Shkreli, better known as the Pharma Bro, Mark Cuban might not have gone into the drug business.
That’s what he told me in this week’s episode of the “First Opinion Podcast.” He first started speaking with Alex Oshmyansky — the radiologist who would become his co-founder in Mark Cuban Cost Plus Drugs — around when Shkreli was heading to prison. Cuban asked about how Shkreli radically raised the price of Daraprim, and the answered startled him. According to Cuban, Oshmyansky said, “‘Well, he can buy it and sell it for whatever he wants, particularly since he’s got an exclusive on the manufacturing.’ I’m like, ‘that’s insane. Let me dig some more in.’ And it became quickly obvious that the pharmacy industry is as opaque as any industry … I’ve ever been involved with, and that the easiest way to counteract opacity is transparency.”
Cuban and I were joined by Matthew Herper, STAT senior writer for medicine and editorial director of events, to discuss pharmacy benefit managers, the 2024 presidential campaign, and how the health care industry should work.
“We’re used to hearing about preauths preventing people from getting their medications,” Cuban said. With PBMs, “it’s the exact opposite. Now, when you talk to people in companies and the HR people about whether or not they’re having denials on preauths, maybe now and then they get step-ups and have to go through different things. But for the highest rebate drugs, they want people.”
Throughout the conversation, as Herper pointed out, Cuban seemed incredibly frustrated with the health care system — not just the PBMs, but also the broader ways that it’s inefficient. “Everything’s an arbitrage. The more complex the system, the easier it is for a company to insert themselves or extend their cost or the friction that they introduce and charge people money for it. And so it does drive me up the wall. But that’s the opportunity as well, because it really should be a 1955 old-school system.” In a rather bold claim, he said, “This is literally the easiest industry to interrupt, to disintermediate, that I’ve ever been involved with.” He even gave a surprisingly specific timeline for when that could happen.
Finally, he weighed in on the 2024 campaign. He’s become a high-profile surrogate of sorts for the Harris-Walz campaign. Of Vice President Kamala Harris, he said, “I don’t think she’s as transactional” as former President Donald Trump. In contrast, when he visited the Trump White House, PBM reform “just it wasn’t something he wanted to talk about when I was in the Oval Office.”
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