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On one hand, we should obviously applaud anyone doing anything to bring down drug prices. On the other hand, I'm increasingly uncomfortable with just how much

On one hand, we should obviously applaud anyone doing anything to bring down drug prices. On the other hand, I'm increasingly uncomfortable with just how much free marketing and PR is being applied to the "Mark Cuban Pharmacy" without much critical examination of what's going on here. Taking one of the examples straight from their homepage: They will sell you 30 Prozac tablets for $3.90: https://costplusdrugs.com/medications/fluoxetine-10mg-capsule/ https://costplusdrugs.com/medications/fluoxetine-10mg-capsul... They list the "Retail price at other pharmacies" as $22.80 and claim to save you $18.90. Fantastic, right? Except nobody should actually be paying $22.80 for generic Prozac. You can drive to any local Walmart and get it for $4 and they will bill your insurance, which will count toward your deductible. (Walmart has a list of their $4 and other cheap prescriptions here: https://www.walmart.com/cp/4-prescriptions/1078664 https://www.walmart.com/cp/4-prescriptions/1078664 ) Mark Cuban's pharmacy, however, refuses to deal with your insurance and they're going to charge an extra $5.00 shipping at checkout. So now you're paying basically twice as much to Mark Cuban's pharmacy even though they're telling you the entire way that you're actually saving money. I also checked my personal insurance and my negotiated rate for the same medication is also less than $5 at local pharmacies. Now of course it's likely that other drugs will work out to be cheaper on Mark Cuban's pharmacy than any other combination of your personal insurance and local pharmacies, but that's far from guaranteed. I'm concerned that Mark Cuban is capitalizing on people's lack of understanding about how insurance works and how easy it can be to look up drug prices (use your insurance company's website or just pick up the phone and call your pharmacy, they'll check for you). His profit margins, however small, rely on people skipping their insurance and going straight to Mark Cuban's pharmacy. That could be fine in some circumstance, but in others, perhaps many other cases, the customer would come out behind by opting out of their insurance. I wish some media outlets would actually dig into this instead of endlessly recycling the company's own talking points verbatim.

jtchang 5y ago
The point is that I have to drive to a local walmart and deal with insurance. That sounds harder.
- PragmaticPulp 5y ago
  Insurance is as simple as handing your insurance card to the pharmacy once. After that, it's in their system. People generally go to the store to buy groceries anyway, so it's not a big deal to pick up a prescription while shopping.
  - WWLink 5y ago
    Most pharmacies also have free delivery (via mail). CVS even does free same day delivery for $5/mo.
- woodruffw 5y ago
  I don't know about other insurance plans, but mine is virtually contact-free: my doctor prescribes me something, and I pick it up at a nearby pharmacy within an hour. The billing is taken care of for me, and I don't hear a peep from the insurance company other than a line item on their monthly letter. OTOH, this seems like a blessing for the un[der]insured. But I took OP's comment to be one of critical optimism, not an attack on the company itself.
  - PragmaticPulp 5y ago
    > I don't know about other insurance plans, but mine is virtually contact-free: my doctor prescribes me something, and I pick it up at a nearby pharmacy within an hour. The billing is taken care of for me, and I don't hear a peep from the insurance company other than a line item on their monthly letter. This is basically standard in 2022. My local pharmacy will even let me convert prescriptions to mail-order with automatic refill with a few clicks online. They'll also phone up my doctor and ask for a 90-day prescription to make it easier if I want. They'll also call the doctor and request refills when the prescription is up. > OTOH, this seems like a blessing for the un[der]insured. Yes, but only if people read the fine print. As in my example above, it's actually more expensive to use Mark Cuban's pharmacy than your local Walmart for many prescriptions. They are relying on people's assumption that it's the cheapest pharmacy around, and nobody in the media seems to be doing anything to investigate that claim. A couple minutes of research shows it's not really true.
jeromegv 5y ago
Are you aware millions of Americans don’t have such insurance?
- PragmaticPulp 5y ago
  Of course I am. Please don't be facetious. But did you even read the comparison? The drug I showed (which was highlighted on Mark Cuban's pharmacy's home page) was still half as expensive by going to a local Walmart. They're relying on a marketing campaign that "all other pharmacies are evil!" and they're hoping none of the media outlets bother to double-check their talking points. So far, it's working.
  - ipaddr 5y ago
    Walmart lowers some prices / raises others based on demand/competition historical prices and are regional. Things are not always cheaper. Everything is part of a huge system trying to extract the most profits. Here is a tip for killing a product at a walmart store: Buy a product out for 2/3 months. Inventory will raise. Stop buying the product. Walmart will delist. Do this at a few stores and get it delisted regionally. Do this to a few regions to kill it nationally. It could be a product that walmart carried for years.. they will still delist.
- refurb 5y ago
  But as to the OP’s point, Mark’s pharmacy is still more expensive for those drugs.
  - Dylan16807 5y ago
    Needing to have it shipped is not a simple "more expensive". Going to a store costs money. It also costs time. It's pretty easy for that to hit $5.
    - PragmaticPulp 5y ago
      > Going to a store costs money. It also costs time. It's pretty easy for that to hit $5. People need groceries. They're going to the store anyway. If you can wait for a mail-order prescription to arrive, you can probably wait until your next grocery shopping trip to get it filled in person.
ctoth 5y ago
> In 2020, 8.6 percent of people, or 28.0 million, did not have health insurance at any point during the year[0]. [0]: https://www.census.gov/library/publications/2021/demo/p60-274.html#:~:text=In%202020%2C%208.6%20percent%20of,part%20of%202020%20was%2091.4 https://www.census.gov/library/publications/2021/demo/p60-27....
- PragmaticPulp 5y ago
  Sure, but the example I highlighted didn't include insurance at all. Still half the price at Walmart. Nobody seems to be even checking the basic facts on this story. Everyone is so eager to dismiss anything insurance-related that they'll take all of the talking points at face value.
  - ctoth 5y ago
    > Except nobody should actually be paying $22.80 for generic Prozac. You can drive to any local Walmart and get it for $4 and they will bill your insurance, which will count toward your deductible. Also there's a ton of stuff that I can buy for $5 at the store and get shipped to me for $10 (I don't own a car so am very aware of this sort of thing), so I'm not sure what the general complaint is here.
    - PragmaticPulp 5y ago
      Continue reading to the part where the same medication is $8.80 from Mark Cuban's pharmacy. The price at Walmart is less than half, regardless of whether or not insurance is involved. The deal is worse for the consumer whether or not insurance is involved.
      - cjbgkagh 5y ago
        I’d pay $5 not to drive. Plus could the shipping be amortized over number of items.
        PragmaticPulp 5y ago
indymike 5y ago
> Except nobody should actually be paying $22.80 for generic Prozac. You can drive to any local Walmart and get it for $4 and they will bill your insurance, which will count toward your deductible. Except people can, and do, all the time. Source: they lady in front of me at the pharmacy counter today, who didn't want any "risky generics".
- thematrixturtle 5y ago
  I also used to think only idiots rejected generics. Then the Ranbaxy scandal happened. https://www.hindustantimes.com/columns/the-scary-truth-behind-generic-drugs-in-india/story-OfuB4lJAwWhBNkvg6pz3sN.html https://www.hindustantimes.com/columns/the-scary-truth-behin...
  - coolso 5y ago
    I used to be okay with generics, until I realized that I wouldn't buy food that I knew was made in India or China. Imagine buying Cinnamon Toast Crunch if it were made in India. So why would I eat a prescription / OTC drug that's made there?
    - thematrixturtle 5y ago
      Bought any cheap pickles lately? (Plain old cucumber dill pickles, that is, not achar etc.) If yes, odds are fairly high they come from India. https://www.india.com/business/india-becomes-pickle-king-of-the-world-emerges-as-largest-exporter-of-cucumber-gherkins-5202365/ https://www.india.com/business/india-becomes-pickle-king-of-...
      - coolso 5y ago
        Thanks, now I know to check the back of my pickle jars before I buy them!
- ALittleLight 5y ago
  Is the lady who didn't want any risky genetics going to buy a generic from Mark Cuban's online pharmacy?
fencepost 5y ago
Following on from this discussion of Walmart's discount drugs, most or all of the pharmacy chains have similar programs, though it's possible that CVS or Walgreens (or both?) require being a member of a paid discount program. IIRC Meijer does free antibiotics and some maternal health stuff, Costco just generally has pretty low prices that are published, Walmart is linked in the parent, Kroger has a variety of free/$3/$6 medications in some kind of association with GoodRX, I didn't see anything for Albertson's on a quick search but there may be one.
gruez 5y ago
>Except nobody should actually be paying $22.80 for generic Prozac. You can drive to any local Walmart and get it for $4 and they will bill your insurance, which will count toward your deductible. (Walmart has a list of their $4 and other cheap prescriptions here: https://www.walmart.com/cp/4-prescriptions/1078664 https://www.walmart.com/cp/4-prescriptions/1078664 ) Can you elaborate on how this works? Are they giving you 30 days' supply of drugs for only $4, even if you have no insurance? Are they charging both insured/uninsured people $4, but billing the insured people more (via insurance) to make up the difference?
- PragmaticPulp 5y ago
  > Can you elaborate on how this works? Are they giving you 30 days' supply of drugs for only $4, even if you have no insurance? Yes, the 30-day supply of those drugs is literally just $4 whether or not you have insurance. Many (but not all) generic drugs are actually super cheap to manufacture. Certain chemicals are basically pennies for a dose, and the production at scale is essentially automated away. For the cheapest drugs, you're paying for the pharmacy to inventory it, dispense it, call your doctor if something goes wrong, and so on. Mark Cuban's pharmacy cuts costs by refusing to do any of the legwork with your doctor or insurance company. Your local neighborhood grocery store pharmacy doesn't mind doing it because they can sell you groceries while they fill it.
waffle_maniac 5y ago
Is the pharmacy cheaper than AllDayChemist (including shipping)? Doesn’t look like it. I guess the wait time and complexity of ADC might not make sense for those without insurance.
- pessimizer 5y ago
  I bet they're easier to sue than AllDayChemist (not that I've ever had a problem with AllDayChemist.)
elliottinvent 5y ago
I’m from the UK > Except nobody should actually be paying $22.80 for generic Prozac. You can drive to any local Walmart and get it for $4 and they will bill your insurance, which will count toward your deductible. FWIW I thought this meant that it was $4 because of “your insurance” or “deductible” but I think you meant it’s $4 for people that aren’t insured? And people that are insured get it for free?
- PragmaticPulp 5y ago
  > FWIW I thought this meant that it was $4 because of “your insurance” or “deductible” but I think you meant it’s $4 for people that aren’t insured? And people that are insured get it for free? No, it's $4 retail at Walmart. $10 for a 3-month supply. People with insurance might also pay the $4 if they haven't reached their insurance deductible (same concept as car/home insurance deductible). Insured people still pay some co-insurance, up until their out-of-pocket maximum.
  - aaaaaaaaaaab 5y ago
    >Insured people still pay some co-insurance, up until their out-of-pocket maximum. I honestly don’t know what this sentence means, and I’m glad I don’t need to deal with such things in the UK.
    - ev1 5y ago
      Imagine you opted for the cheap $500/month plan. You might have to pay 50% or 100% of all costs until you reach your maximum, which might be 5 digits and resets at least annually. Don't forget the "out of network" vs "in network" separation/cost/caps, where your physical hospital may be in network but a provider that works there is billed out of network. See also: https://en.wikipedia.org/wiki/High-deductible_health_plan https://en.wikipedia.org/wiki/High-deductible_health_plan
treis 5y ago
The amazing thing is that he's telling everyone exactly what he's doing. He wants to extract 15% as a middleman in an industry that transacts 100+ billion a year. All for running a simple website and taking on a tiny bit of transaction risk. And people think it's a charity instead of business worth billions.
- toomuchtodo 5y ago
  In America, it is a charity effectively to provide what is essentially a public service by “only” taking a 15% cut on generics when other manufacturers are selling at magnitudes higher costs. It’s Costco for generic meds. No one calls Costco a charity, but their employees and customers love them for being fair and their business is held up as an example of how to create value from customer loyalty. And they still generate value for their shareholders. If you have insurance, this is likely not for you. If you are uninsured, this could be huge for you. Perspective is important.
  - deleted 5y ago
    [deleted]
  - BurningFrog 5y ago
    Costco already is Costco for generic meds! What I've heard (not researched) is that they typically have the lowest drug prices.
    - toomuchtodo 5y ago
      They are cheaper than Costco on several drugs based on a comparison performed within the last 20 days.
  - treis 5y ago
    (1) His prices aren't really any better than retail pharmacy with GoodRx. The generics for little money is well covered. (2) Costco actually does shit. They build buildings, hire pharmacists, buy inventory in bulk, and sell it to you in the store. Cuban has a website that takes 3 months to build and a little bit of transaction risk.
bmarquez 5y ago
> Mark Cuban's pharmacy, however, refuses to deal with your insurance I don't see a problem with this. Some insurance plans are can be hard to deal with. My personal experiences involve requiring step therapy (trying a cheaper, possibly less effective drug) before approving the prescription. Another experience is that a drug may only be covered for one condition but not for another (e.g. finasteride for hair loss vs finasteride for enlarged prostate). If Cuban wants to avoid the headache of dealing with formulary lists, I don't blame him. Obviously consumers should compare prices whenever possible, but if the difference is only a few dollars I'd probably rather pay Cuban directly than deal with the Walmart retail experience.
- PragmaticPulp 5y ago
  > My personal experiences involve requiring step therapy (trying a cheaper, possibly less effective drug) before approving the prescription. FYI, Mark Cuban's pharmacy only deals in generic medications. Most of the "step therapy" programs exist to gate the non-generic medications, so you wouldn't be finding them at Mark Cuban's pharmacy anyway. Also, you don't need insurance to use a traditional pharmacy. You should still cross-shop online regardless. I think too many people have misinterpreted Mark Cuban's PR as having solved all of the problems with insurance, but it's really just another retailer of generic medications like countless others online. They said they plan to do their own manufacturing in the future, but at the moment they're buying from the same wholesalers as all the other online discount pharmacies. They've just attached Mark Cuban's name to this one.
  - nimos 5y ago
    > Most of the "step therapy" programs exist to gate the non-generic medications, so you wouldn't be finding them at Mark Cuban's pharmacy anyway. I had to go through PA for 2 generic drugs that cost ~10-15 each a month from Costco (according to GoodRX). Cost Plus is actually a bit more expensive with shipping. If its $5 shipping total and not per drug its a small saving but wouldn't count towards my deductible. Was a huge hassle. I'm pretty sure if you were to take the time*wage my pharmacist, my doctor and myself spent on getting it done it would have paid for the prescriptions for at least a decade. Oh and I'm on a high deductible plan so it will probably never cost them anything because I probably won't hit my coinsurance/out of pocket max.
dannyphantom 5y ago
I've been frustrated with the 'Mark Cuban Pharmacy' for weeks now as well. At the end of the day, it is a way to capitalize on a lucrative industry and as you've pointed out, doesn't always work out in such a way that consumers will be better off for solely going through this new pharmacy venture.
samstave 5y ago
But what rate is my insurance "billing" for the total price of the transaction with my insurance? So - while you may be able to get nearish the same price (before the shipping) <-- But am I consuming less of my insurance and also paying less to insurance companies, which are just hedge funds anyway... So, if Mark Cuban the Billionaire can start a pharmacy model such as this, not dealing with insurance, then what precludes market competition with his pharmacy? Franchise license with supply chain to open ones own brick and mortar etc... Serious questions.
- ipaddr 5y ago
  Drug companies selling directly? Brick and Mortor stores selling without dealer discounts? Or others copying and marking up only 10% or 5%? I guess nothing but greed stopped this before.
  - samstave 5y ago
    The most F'd up thing about our medical institution in the US, is that while "you must have insurance" is regulated - depending on the size of the Hospital Group - they all can (Could - may have changed since I last built a hospital) negotiate their individual rate with each insurance company based on the size/volume of patients. This is wrong. The coding for a given procedure should be standardized and priced as such. This simple change could do great things for leveling the playing field for the nation of healthcare ; If regardless of your volume of encounters on a particular code, the price should be set. This may do several things: Make rural hospitals/clinics more competitive with a major hospitals. In my experience though - the big spending in non-medical areas that hospitals have are around "comfort aesthetics" (Art, pretty buildings etc) Hospitals which cost $400MM -- to $1B facility (2009) spent a LOT on art. They seek donors constantly... Maybe they should have the rich donors, as a requirement for their contribution, also require they provide a loaner art install. This way - lets say you donate $1MM to a hospital, 100% of that donation should go to actual clinical build etc.. and the hospital should be precluded from your financial donation from being used to pay a digital arts company from being paid their ~250K fee through your donation... I've built quite a few big facilities and art is a HUGE aspect in the health aesthetics of an environment ; but the cost is always exorbitant. Personally, having managed the install of such - I think that this should be outside of what the hospital should spend money on - unless the donation is specifically for art/aesthetics... This lightens the build cost for large hospitals. Source designer/TPM/etc on: - El Camino CA (I just got this today: https://i.imgur.com/KFCX4N0.jpg https://i.imgur.com/KFCX4N0.jpg) - UCSF CA - NOME AK - Sequoia CA - Methodist CA - Others I cant even recall now... --- All of these costs get baked into the overall cost of the facility - and guess who pays for that? (not only in monetary costs) My brother was the head of the VA for AK - commander of 10th medical wing for the USAF and is currently the CMO for the largest hospital group in AK. Familiar with both sides of the table on price-fixing... I don't have pharma exp WRT drug costs... just sunk costs in the facilities I build - but I get info from my brother on certain things... but pharma prices need to be heavily reg'd
Crazyontap 5y ago
> You can drive to any local Walmart and get it for $4 and they will bill your insurance > and they're going to charge an extra $5.00 shipping at checkout I'd say driving to wallmart and dealing with insurance can be as much as $5 worth of gas and time for some.
- tzs 5y ago
  $4 is the cash price for (most) Walmart generics. You can just pay that yourself and not deal with insurance if you prefer. It’s $10 for a 90 day supply if your want to cut down on the driving.
gm 5y ago
I'm not sure what your point is: It seems you are cherrypicking and then generalizing. For example Duloxetine (generic for Cymbalta) is $4 at CostPlus and $15 at the Walmart link. That in and of itself really does not prove anything either. I may be wrong, though, it's just one additional data point. Maybe you can do the analysis you mention and publish it? The worst that will happen is that all us laypeople will be better informed. I think though that CostPlus, if nothing else, has opened the eyes of a great many people who just assumed medicine was like any other product where the manufacturer controls the price and if someone is making obscene profit, it's an outlier like the Shkreli douchebag. Now a lot more people know that it's possible to pay a lot less. Even on TikTok I'm seeing people paying much less for their prescriptions when they bypass the insurance company and pay full retail price, which is counterintuitive as hell, and I personally would have never guessed. So all in all, I think it's hugely positive that the secrets are getting out, and CostPlus is invariably a large part of that.
- thaumasiotes 5y ago
  > I think though that CostPlus, if nothing else, has opened the eyes of a great many people who just assumed medicine was like any other product where the manufacturer controls the price Like any other product? There are zero products like that. Manufacturers aren't legally able to control the price even if they propose a contract with a resale price clause. That's why everything has a "manufacturer's suggested retail price" printed on it.
  - kQq9oHeAz6wLLS 5y ago
    Unless the manufacturer is also the retailer, such as Tesla
  - gm 5y ago
    I meant the manufacturer controls the price at which they sell. Ie, if drug X costs $15 to make, and the manufacturer chooses to sell it to retailers/distributors at $2000, they are free to do that.
    - 5y ago
jcims 5y ago
It's basically the Spirit Airlines of pharmacies. >Mark Cuban's pharmacy, however, refuses to deal with your insurance I would say this is a net good. It significantly reduces their costs. Also there are many, possibly the majority of, cases where their prices are substantially cheaper than Walmart. https://www.walmart.com/cp/4-prescriptions/1078664 https://www.walmart.com/cp/4-prescriptions/1078664 https://costplusdrugs.com/medications/ https://costplusdrugs.com/medications/
pc86 5y ago
Well, if you need something shipped to you, you're probably paying for it if it's not a loss leader/cost-of-business for the shipper. Buy something from Walmart and they're charging you shipping if you're not having it sent to one of their stairs. So you can't lump in shipping on one end and ignore it on the other. Your entire criticism seems to be "there may be specific circumstances in which this isn't actually cheaper, and that's bad because Mark Cuban."
fastball 5y ago
Isn't that exactly the problem? When you factor in the cost of health insurance, Americans pay a buttload for healthcare compared to the rest of the developed world. A big proportion of this is because when people see expensive drugs they just ¯\_(ツ)_/¯ and say "my insurance pays for it". All this once-removed cost makes it hard for people to reason about what they are overpaying for as an individual so as a society we end up overpaying for everything. This is the same reason hospitals in America have incredibly convoluted and confusing and opaque billing practices – the harder it is to parse the true price you're paying for something (esp. in advance), the harder it is to vote with your wallet.
- zdragnar 5y ago
  Hospital profit margins are razor thin in the US. Their pricing is so convoluted because they have to come up with inane contracts with insurance companies to squeeze out every dollar they can. In some instances, doctors in private practices have told me that taking Medicare or Medicaid means making less than minimum wage for certain procedures because the rates are fixed at such low values. In other cases, ER and intensive care units make nothing because they cannot legally turn anyone away for not being able to pay. All of that has to be made up somewhere, and bilking insurance companies when they can are how they stay afloat. Big companies can take the hit on high insurance rates. Drug makers live in boom and bust cycles (drugs are either fabulous money makers or bottomless pits that suck money from research, to testing, to the famously expensive FDA approval process). The people hurt the worst are the small business employees and owners, the self employed, and the part time workers who can't afford to have the hospital come after them.
  - fastball 5y ago
    So hospitals and drug companies in the US are operating at peak efficiency without bilking anyone unnecessarily and yet a huge variety of procedures are more expensive than in the rest of the developed world. That definitely passes a smell test.
    - s1artibartfast 5y ago
akomtu 5y ago
Your walmart link is quite a discovery for me. I've always been suspicious when my pharmacy congratulates me on saving whopping 200 bucks on my generic meds, but I couldn't have imagined that a one year supply of this stuff can be had for under 40 bucks at walmart. In other words, my pharmacy's markup exceeds 50x of the original price (probably 100x since they buy it in bulk).
- csdvrx 5y ago
  > In other words, my pharmacy's markup exceeds 50x of the original price (probably 100x since they buy it in bulk). A cool plot twist would be if your pharmacy purchased the drugs from Walmart, and just put them in a cute orange box with a nice sticker showing their name :)
briHass 5y ago
>I'm concerned that Mark Cuban is capitalizing on people's lack of understanding about how insurance works and how easy it can be to look up drug prices (use your insurance company's website or just pick up the phone and call your pharmacy, they'll check for you) That certainly hasn't been my experience. Most pharmacies I've tried this with need to actually 'fill' the script and run it through insurance to get a final price. And, in the era of 'COVID-related staffing shortages', good luck calling the pharmacy and actually getting someone on the line. The sad thing is, all these pharmacies know about GoodRx and other discount providers. They could stop playing games and just run all scripts through these providers to get a 'cash price', but they don't. It's honestly like shopping at Kohls where if you aren't stacking coupons, you're the sucker paying too much. I don't know about Cuban's mechanics here, but a website that shows you the final price, no games/codes, is a great addition to the market.
- alphabettsy 5y ago
  > The sad thing is, all these pharmacies know about GoodRx and other discount providers. They could stop playing games and just run all scripts through these providers to get a 'cash price', but they don't. They aren’t allowed to contractually. The PBMs and insurance companies make pharmacies sign contracts that forbid them from doing this. They also forbid pharmacies from telling customers if it would be cheaper to pay cash. Most states have only a few major insurance companies and getting caught and losing the ability to serve a large portion of clients would put most pharmacies out of business.
  - mindslight 5y ago
    Prohibiting such anticompetitive cartel behavior is yet another straightforward market reform that could be implemented tomorrow, if our political process weren't merely a game between providers and "insurers".
    - s1artibartfast 5y ago
      Agreed. This Is I why I think it is good that someone is cutting insurance and PBMs out of the supply chain.
wnevets 5y ago
> anything to bring down drug prices. On the other hand, I'm increasingly uncomfortable with just how much free marketing and PR is being applied to the "Mark Cuban Pharmacy" without much critical examination of what's going on here. I've avoided simple things like up voting stories about it for exactly this reason. Sure the headline sounds great but without actually going through the math and how the site works who knows if it's actually good.
hyperhopper 5y ago
You should read the submarine [0], a great article on why this happens that I found here on HN. TL;DR: writing news is hard and journalists are overworked and underpaid. Media firms for companies basically write these articles for journalists, and since they aren't technically false everybody wins (except the reader) because the news agency gets a lot of "news" and the companies get exactly the spin they want. [0]: http://www.paulgraham.com/submarine.html http://www.paulgraham.com/submarine.html
BurningFrog 5y ago
> just pick up the phone and call your pharmacy It's 2022, and if your prices are not on a web page, they're clearly not a selling point.
MaxLeiter 5y ago
Many people prefer dealing with cash and don’t want to go to the pharmacy.
helloworld11 5y ago
Your point being what? You seem to be saying: "But it's still better with insurance and in any case it's not as ideal as I'd like (as an insured person with decent insurance)" Okay, and what about the simple fact that for those people (many millions of them) who do not have insurance, or have shitty, finicky insurance, this is still a considerable possible improvement? You extrapolate your privileged position to create a whole criticism of a more viable and affordable way of buying medicine that many people outside your situation would maybe embrace because they lack the same options.

jtchang 5y ago

The point is that I have to drive to a local walmart and deal with insurance. That sounds harder.

PragmaticPulp 5y ago
Insurance is as simple as handing your insurance card to the pharmacy once. After that, it's in their system. People generally go to the store to buy groceries anyway, so it's not a big deal to pick up a prescription while shopping.
- WWLink 5y ago
  Most pharmacies also have free delivery (via mail). CVS even does free same day delivery for $5/mo.
woodruffw 5y ago
I don't know about other insurance plans, but mine is virtually contact-free: my doctor prescribes me something, and I pick it up at a nearby pharmacy within an hour. The billing is taken care of for me, and I don't hear a peep from the insurance company other than a line item on their monthly letter. OTOH, this seems like a blessing for the un[der]insured. But I took OP's comment to be one of critical optimism, not an attack on the company itself.
- PragmaticPulp 5y ago
  > I don't know about other insurance plans, but mine is virtually contact-free: my doctor prescribes me something, and I pick it up at a nearby pharmacy within an hour. The billing is taken care of for me, and I don't hear a peep from the insurance company other than a line item on their monthly letter. This is basically standard in 2022. My local pharmacy will even let me convert prescriptions to mail-order with automatic refill with a few clicks online. They'll also phone up my doctor and ask for a 90-day prescription to make it easier if I want. They'll also call the doctor and request refills when the prescription is up. > OTOH, this seems like a blessing for the un[der]insured. Yes, but only if people read the fine print. As in my example above, it's actually more expensive to use Mark Cuban's pharmacy than your local Walmart for many prescriptions. They are relying on people's assumption that it's the cheapest pharmacy around, and nobody in the media seems to be doing anything to investigate that claim. A couple minutes of research shows it's not really true.

jeromegv 5y ago

Are you aware millions of Americans don’t have such insurance?

PragmaticPulp 5y ago
Of course I am. Please don't be facetious. But did you even read the comparison? The drug I showed (which was highlighted on Mark Cuban's pharmacy's home page) was still half as expensive by going to a local Walmart. They're relying on a marketing campaign that "all other pharmacies are evil!" and they're hoping none of the media outlets bother to double-check their talking points. So far, it's working.
- ipaddr 5y ago
  Walmart lowers some prices / raises others based on demand/competition historical prices and are regional. Things are not always cheaper. Everything is part of a huge system trying to extract the most profits. Here is a tip for killing a product at a walmart store: Buy a product out for 2/3 months. Inventory will raise. Stop buying the product. Walmart will delist. Do this at a few stores and get it delisted regionally. Do this to a few regions to kill it nationally. It could be a product that walmart carried for years.. they will still delist.
refurb 5y ago
But as to the OP’s point, Mark’s pharmacy is still more expensive for those drugs.
- Dylan16807 5y ago
  Needing to have it shipped is not a simple "more expensive". Going to a store costs money. It also costs time. It's pretty easy for that to hit $5.
  - PragmaticPulp 5y ago
    > Going to a store costs money. It also costs time. It's pretty easy for that to hit $5. People need groceries. They're going to the store anyway. If you can wait for a mail-order prescription to arrive, you can probably wait until your next grocery shopping trip to get it filled in person.

ctoth 5y ago

> In 2020, 8.6 percent of people, or 28.0 million, did not have health insurance at any point during the year[0]. [0]: https://www.census.gov/library/publications/2021/demo/p60-274.html#:~:text=In%202020%2C%208.6%20percent%20of,part%20of%202020%20was%2091.4 https://www.census.gov/library/publications/2021/demo/p60-27....

PragmaticPulp 5y ago
Sure, but the example I highlighted didn't include insurance at all. Still half the price at Walmart. Nobody seems to be even checking the basic facts on this story. Everyone is so eager to dismiss anything insurance-related that they'll take all of the talking points at face value.
- ctoth 5y ago
  > Except nobody should actually be paying $22.80 for generic Prozac. You can drive to any local Walmart and get it for $4 and they will bill your insurance, which will count toward your deductible. Also there's a ton of stuff that I can buy for $5 at the store and get shipped to me for $10 (I don't own a car so am very aware of this sort of thing), so I'm not sure what the general complaint is here.
  - PragmaticPulp 5y ago
    Continue reading to the part where the same medication is $8.80 from Mark Cuban's pharmacy. The price at Walmart is less than half, regardless of whether or not insurance is involved. The deal is worse for the consumer whether or not insurance is involved.
    - cjbgkagh 5y ago
      I’d pay $5 not to drive. Plus could the shipping be amortized over number of items.
      - PragmaticPulp 5y ago

indymike 5y ago

> Except nobody should actually be paying $22.80 for generic Prozac. You can drive to any local Walmart and get it for $4 and they will bill your insurance, which will count toward your deductible. Except people can, and do, all the time. Source: they lady in front of me at the pharmacy counter today, who didn't want any "risky generics".

thematrixturtle 5y ago
I also used to think only idiots rejected generics. Then the Ranbaxy scandal happened. https://www.hindustantimes.com/columns/the-scary-truth-behind-generic-drugs-in-india/story-OfuB4lJAwWhBNkvg6pz3sN.html https://www.hindustantimes.com/columns/the-scary-truth-behin...
- coolso 5y ago
  I used to be okay with generics, until I realized that I wouldn't buy food that I knew was made in India or China. Imagine buying Cinnamon Toast Crunch if it were made in India. So why would I eat a prescription / OTC drug that's made there?
  - thematrixturtle 5y ago
    Bought any cheap pickles lately? (Plain old cucumber dill pickles, that is, not achar etc.) If yes, odds are fairly high they come from India. https://www.india.com/business/india-becomes-pickle-king-of-the-world-emerges-as-largest-exporter-of-cucumber-gherkins-5202365/ https://www.india.com/business/india-becomes-pickle-king-of-...
    - coolso 5y ago
      Thanks, now I know to check the back of my pickle jars before I buy them!
ALittleLight 5y ago
Is the lady who didn't want any risky genetics going to buy a generic from Mark Cuban's online pharmacy?

fencepost 5y ago

Following on from this discussion of Walmart's discount drugs, most or all of the pharmacy chains have similar programs, though it's possible that CVS or Walgreens (or both?) require being a member of a paid discount program. IIRC Meijer does free antibiotics and some maternal health stuff, Costco just generally has pretty low prices that are published, Walmart is linked in the parent, Kroger has a variety of free/$3/$6 medications in some kind of association with GoodRX, I didn't see anything for Albertson's on a quick search but there may be one.

gruez 5y ago

>Except nobody should actually be paying $22.80 for generic Prozac. You can drive to any local Walmart and get it for $4 and they will bill your insurance, which will count toward your deductible. (Walmart has a list of their $4 and other cheap prescriptions here: https://www.walmart.com/cp/4-prescriptions/1078664 https://www.walmart.com/cp/4-prescriptions/1078664 ) Can you elaborate on how this works? Are they giving you 30 days' supply of drugs for only $4, even if you have no insurance? Are they charging both insured/uninsured people $4, but billing the insured people more (via insurance) to make up the difference?

PragmaticPulp 5y ago
> Can you elaborate on how this works? Are they giving you 30 days' supply of drugs for only $4, even if you have no insurance? Yes, the 30-day supply of those drugs is literally just $4 whether or not you have insurance. Many (but not all) generic drugs are actually super cheap to manufacture. Certain chemicals are basically pennies for a dose, and the production at scale is essentially automated away. For the cheapest drugs, you're paying for the pharmacy to inventory it, dispense it, call your doctor if something goes wrong, and so on. Mark Cuban's pharmacy cuts costs by refusing to do any of the legwork with your doctor or insurance company. Your local neighborhood grocery store pharmacy doesn't mind doing it because they can sell you groceries while they fill it.

waffle_maniac 5y ago

Is the pharmacy cheaper than AllDayChemist (including shipping)? Doesn’t look like it. I guess the wait time and complexity of ADC might not make sense for those without insurance.

pessimizer 5y ago
I bet they're easier to sue than AllDayChemist (not that I've ever had a problem with AllDayChemist.)

elliottinvent 5y ago

I’m from the UK > Except nobody should actually be paying $22.80 for generic Prozac. You can drive to any local Walmart and get it for $4 and they will bill your insurance, which will count toward your deductible. FWIW I thought this meant that it was $4 because of “your insurance” or “deductible” but I think you meant it’s $4 for people that aren’t insured? And people that are insured get it for free?

PragmaticPulp 5y ago
> FWIW I thought this meant that it was $4 because of “your insurance” or “deductible” but I think you meant it’s $4 for people that aren’t insured? And people that are insured get it for free? No, it's $4 retail at Walmart. $10 for a 3-month supply. People with insurance might also pay the $4 if they haven't reached their insurance deductible (same concept as car/home insurance deductible). Insured people still pay some co-insurance, up until their out-of-pocket maximum.
- aaaaaaaaaaab 5y ago
  >Insured people still pay some co-insurance, up until their out-of-pocket maximum. I honestly don’t know what this sentence means, and I’m glad I don’t need to deal with such things in the UK.
  - ev1 5y ago
    Imagine you opted for the cheap $500/month plan. You might have to pay 50% or 100% of all costs until you reach your maximum, which might be 5 digits and resets at least annually. Don't forget the "out of network" vs "in network" separation/cost/caps, where your physical hospital may be in network but a provider that works there is billed out of network. See also: https://en.wikipedia.org/wiki/High-deductible_health_plan https://en.wikipedia.org/wiki/High-deductible_health_plan

treis 5y ago

The amazing thing is that he's telling everyone exactly what he's doing. He wants to extract 15% as a middleman in an industry that transacts 100+ billion a year. All for running a simple website and taking on a tiny bit of transaction risk. And people think it's a charity instead of business worth billions.

toomuchtodo 5y ago
In America, it is a charity effectively to provide what is essentially a public service by “only” taking a 15% cut on generics when other manufacturers are selling at magnitudes higher costs. It’s Costco for generic meds. No one calls Costco a charity, but their employees and customers love them for being fair and their business is held up as an example of how to create value from customer loyalty. And they still generate value for their shareholders. If you have insurance, this is likely not for you. If you are uninsured, this could be huge for you. Perspective is important.
- deleted 5y ago
  [deleted]
- BurningFrog 5y ago
  Costco already is Costco for generic meds! What I've heard (not researched) is that they typically have the lowest drug prices.
  - toomuchtodo 5y ago
    They are cheaper than Costco on several drugs based on a comparison performed within the last 20 days.
- treis 5y ago
  (1) His prices aren't really any better than retail pharmacy with GoodRx. The generics for little money is well covered. (2) Costco actually does shit. They build buildings, hire pharmacists, buy inventory in bulk, and sell it to you in the store. Cuban has a website that takes 3 months to build and a little bit of transaction risk.

bmarquez 5y ago

> Mark Cuban's pharmacy, however, refuses to deal with your insurance I don't see a problem with this. Some insurance plans are can be hard to deal with. My personal experiences involve requiring step therapy (trying a cheaper, possibly less effective drug) before approving the prescription. Another experience is that a drug may only be covered for one condition but not for another (e.g. finasteride for hair loss vs finasteride for enlarged prostate). If Cuban wants to avoid the headache of dealing with formulary lists, I don't blame him. Obviously consumers should compare prices whenever possible, but if the difference is only a few dollars I'd probably rather pay Cuban directly than deal with the Walmart retail experience.

PragmaticPulp 5y ago
> My personal experiences involve requiring step therapy (trying a cheaper, possibly less effective drug) before approving the prescription. FYI, Mark Cuban's pharmacy only deals in generic medications. Most of the "step therapy" programs exist to gate the non-generic medications, so you wouldn't be finding them at Mark Cuban's pharmacy anyway. Also, you don't need insurance to use a traditional pharmacy. You should still cross-shop online regardless. I think too many people have misinterpreted Mark Cuban's PR as having solved all of the problems with insurance, but it's really just another retailer of generic medications like countless others online. They said they plan to do their own manufacturing in the future, but at the moment they're buying from the same wholesalers as all the other online discount pharmacies. They've just attached Mark Cuban's name to this one.
- nimos 5y ago
  > Most of the "step therapy" programs exist to gate the non-generic medications, so you wouldn't be finding them at Mark Cuban's pharmacy anyway. I had to go through PA for 2 generic drugs that cost ~10-15 each a month from Costco (according to GoodRX). Cost Plus is actually a bit more expensive with shipping. If its $5 shipping total and not per drug its a small saving but wouldn't count towards my deductible. Was a huge hassle. I'm pretty sure if you were to take the time*wage my pharmacist, my doctor and myself spent on getting it done it would have paid for the prescriptions for at least a decade. Oh and I'm on a high deductible plan so it will probably never cost them anything because I probably won't hit my coinsurance/out of pocket max.

dannyphantom 5y ago

I've been frustrated with the 'Mark Cuban Pharmacy' for weeks now as well. At the end of the day, it is a way to capitalize on a lucrative industry and as you've pointed out, doesn't always work out in such a way that consumers will be better off for solely going through this new pharmacy venture.

samstave 5y ago

But what rate is my insurance "billing" for the total price of the transaction with my insurance? So - while you may be able to get nearish the same price (before the shipping) <-- But am I consuming less of my insurance and also paying less to insurance companies, which are just hedge funds anyway... So, if Mark Cuban the Billionaire can start a pharmacy model such as this, not dealing with insurance, then what precludes market competition with his pharmacy? Franchise license with supply chain to open ones own brick and mortar etc... Serious questions.

ipaddr 5y ago
Drug companies selling directly? Brick and Mortor stores selling without dealer discounts? Or others copying and marking up only 10% or 5%? I guess nothing but greed stopped this before.
- samstave 5y ago
  The most F'd up thing about our medical institution in the US, is that while "you must have insurance" is regulated - depending on the size of the Hospital Group - they all can (Could - may have changed since I last built a hospital) negotiate their individual rate with each insurance company based on the size/volume of patients. This is wrong. The coding for a given procedure should be standardized and priced as such. This simple change could do great things for leveling the playing field for the nation of healthcare ; If regardless of your volume of encounters on a particular code, the price should be set. This may do several things: Make rural hospitals/clinics more competitive with a major hospitals. In my experience though - the big spending in non-medical areas that hospitals have are around "comfort aesthetics" (Art, pretty buildings etc) Hospitals which cost $400MM -- to $1B facility (2009) spent a LOT on art. They seek donors constantly... Maybe they should have the rich donors, as a requirement for their contribution, also require they provide a loaner art install. This way - lets say you donate $1MM to a hospital, 100% of that donation should go to actual clinical build etc.. and the hospital should be precluded from your financial donation from being used to pay a digital arts company from being paid their ~250K fee through your donation... I've built quite a few big facilities and art is a HUGE aspect in the health aesthetics of an environment ; but the cost is always exorbitant. Personally, having managed the install of such - I think that this should be outside of what the hospital should spend money on - unless the donation is specifically for art/aesthetics... This lightens the build cost for large hospitals. Source designer/TPM/etc on: - El Camino CA (I just got this today: https://i.imgur.com/KFCX4N0.jpg https://i.imgur.com/KFCX4N0.jpg) - UCSF CA - NOME AK - Sequoia CA - Methodist CA - Others I cant even recall now... --- All of these costs get baked into the overall cost of the facility - and guess who pays for that? (not only in monetary costs) My brother was the head of the VA for AK - commander of 10th medical wing for the USAF and is currently the CMO for the largest hospital group in AK. Familiar with both sides of the table on price-fixing... I don't have pharma exp WRT drug costs... just sunk costs in the facilities I build - but I get info from my brother on certain things... but pharma prices need to be heavily reg'd

Crazyontap 5y ago

> You can drive to any local Walmart and get it for $4 and they will bill your insurance > and they're going to charge an extra $5.00 shipping at checkout I'd say driving to wallmart and dealing with insurance can be as much as $5 worth of gas and time for some.

tzs 5y ago
$4 is the cash price for (most) Walmart generics. You can just pay that yourself and not deal with insurance if you prefer. It’s $10 for a 90 day supply if your want to cut down on the driving.

gm 5y ago

I'm not sure what your point is: It seems you are cherrypicking and then generalizing. For example Duloxetine (generic for Cymbalta) is $4 at CostPlus and $15 at the Walmart link. That in and of itself really does not prove anything either. I may be wrong, though, it's just one additional data point. Maybe you can do the analysis you mention and publish it? The worst that will happen is that all us laypeople will be better informed. I think though that CostPlus, if nothing else, has opened the eyes of a great many people who just assumed medicine was like any other product where the manufacturer controls the price and if someone is making obscene profit, it's an outlier like the Shkreli douchebag. Now a lot more people know that it's possible to pay a lot less. Even on TikTok I'm seeing people paying much less for their prescriptions when they bypass the insurance company and pay full retail price, which is counterintuitive as hell, and I personally would have never guessed. So all in all, I think it's hugely positive that the secrets are getting out, and CostPlus is invariably a large part of that.

thaumasiotes 5y ago
> I think though that CostPlus, if nothing else, has opened the eyes of a great many people who just assumed medicine was like any other product where the manufacturer controls the price Like any other product? There are zero products like that. Manufacturers aren't legally able to control the price even if they propose a contract with a resale price clause. That's why everything has a "manufacturer's suggested retail price" printed on it.
- kQq9oHeAz6wLLS 5y ago
  Unless the manufacturer is also the retailer, such as Tesla
- gm 5y ago
  I meant the manufacturer controls the price at which they sell. Ie, if drug X costs $15 to make, and the manufacturer chooses to sell it to retailers/distributors at $2000, they are free to do that.
  - 5y ago

jcims 5y ago

It's basically the Spirit Airlines of pharmacies. >Mark Cuban's pharmacy, however, refuses to deal with your insurance I would say this is a net good. It significantly reduces their costs. Also there are many, possibly the majority of, cases where their prices are substantially cheaper than Walmart. https://www.walmart.com/cp/4-prescriptions/1078664 https://www.walmart.com/cp/4-prescriptions/1078664 https://costplusdrugs.com/medications/ https://costplusdrugs.com/medications/

pc86 5y ago

Well, if you need something shipped to you, you're probably paying for it if it's not a loss leader/cost-of-business for the shipper. Buy something from Walmart and they're charging you shipping if you're not having it sent to one of their stairs. So you can't lump in shipping on one end and ignore it on the other. Your entire criticism seems to be "there may be specific circumstances in which this isn't actually cheaper, and that's bad because Mark Cuban."

fastball 5y ago

Isn't that exactly the problem? When you factor in the cost of health insurance, Americans pay a buttload for healthcare compared to the rest of the developed world. A big proportion of this is because when people see expensive drugs they just ¯\_(ツ)_/¯ and say "my insurance pays for it". All this once-removed cost makes it hard for people to reason about what they are overpaying for as an individual so as a society we end up overpaying for everything. This is the same reason hospitals in America have incredibly convoluted and confusing and opaque billing practices – the harder it is to parse the true price you're paying for something (esp. in advance), the harder it is to vote with your wallet.

zdragnar 5y ago
Hospital profit margins are razor thin in the US. Their pricing is so convoluted because they have to come up with inane contracts with insurance companies to squeeze out every dollar they can. In some instances, doctors in private practices have told me that taking Medicare or Medicaid means making less than minimum wage for certain procedures because the rates are fixed at such low values. In other cases, ER and intensive care units make nothing because they cannot legally turn anyone away for not being able to pay. All of that has to be made up somewhere, and bilking insurance companies when they can are how they stay afloat. Big companies can take the hit on high insurance rates. Drug makers live in boom and bust cycles (drugs are either fabulous money makers or bottomless pits that suck money from research, to testing, to the famously expensive FDA approval process). The people hurt the worst are the small business employees and owners, the self employed, and the part time workers who can't afford to have the hospital come after them.
- fastball 5y ago
  So hospitals and drug companies in the US are operating at peak efficiency without bilking anyone unnecessarily and yet a huge variety of procedures are more expensive than in the rest of the developed world. That definitely passes a smell test.
  - s1artibartfast 5y ago

akomtu 5y ago

Your walmart link is quite a discovery for me. I've always been suspicious when my pharmacy congratulates me on saving whopping 200 bucks on my generic meds, but I couldn't have imagined that a one year supply of this stuff can be had for under 40 bucks at walmart. In other words, my pharmacy's markup exceeds 50x of the original price (probably 100x since they buy it in bulk).

csdvrx 5y ago
> In other words, my pharmacy's markup exceeds 50x of the original price (probably 100x since they buy it in bulk). A cool plot twist would be if your pharmacy purchased the drugs from Walmart, and just put them in a cute orange box with a nice sticker showing their name :)

briHass 5y ago

>I'm concerned that Mark Cuban is capitalizing on people's lack of understanding about how insurance works and how easy it can be to look up drug prices (use your insurance company's website or just pick up the phone and call your pharmacy, they'll check for you) That certainly hasn't been my experience. Most pharmacies I've tried this with need to actually 'fill' the script and run it through insurance to get a final price. And, in the era of 'COVID-related staffing shortages', good luck calling the pharmacy and actually getting someone on the line. The sad thing is, all these pharmacies know about GoodRx and other discount providers. They could stop playing games and just run all scripts through these providers to get a 'cash price', but they don't. It's honestly like shopping at Kohls where if you aren't stacking coupons, you're the sucker paying too much. I don't know about Cuban's mechanics here, but a website that shows you the final price, no games/codes, is a great addition to the market.

alphabettsy 5y ago
> The sad thing is, all these pharmacies know about GoodRx and other discount providers. They could stop playing games and just run all scripts through these providers to get a 'cash price', but they don't. They aren’t allowed to contractually. The PBMs and insurance companies make pharmacies sign contracts that forbid them from doing this. They also forbid pharmacies from telling customers if it would be cheaper to pay cash. Most states have only a few major insurance companies and getting caught and losing the ability to serve a large portion of clients would put most pharmacies out of business.
- mindslight 5y ago
  Prohibiting such anticompetitive cartel behavior is yet another straightforward market reform that could be implemented tomorrow, if our political process weren't merely a game between providers and "insurers".
  - s1artibartfast 5y ago
    Agreed. This Is I why I think it is good that someone is cutting insurance and PBMs out of the supply chain.

wnevets 5y ago

> anything to bring down drug prices. On the other hand, I'm increasingly uncomfortable with just how much free marketing and PR is being applied to the "Mark Cuban Pharmacy" without much critical examination of what's going on here. I've avoided simple things like up voting stories about it for exactly this reason. Sure the headline sounds great but without actually going through the math and how the site works who knows if it's actually good.

hyperhopper 5y ago

You should read the submarine [0], a great article on why this happens that I found here on HN. TL;DR: writing news is hard and journalists are overworked and underpaid. Media firms for companies basically write these articles for journalists, and since they aren't technically false everybody wins (except the reader) because the news agency gets a lot of "news" and the companies get exactly the spin they want. [0]: http://www.paulgraham.com/submarine.html http://www.paulgraham.com/submarine.html

BurningFrog 5y ago

> just pick up the phone and call your pharmacy It's 2022, and if your prices are not on a web page, they're clearly not a selling point.

MaxLeiter 5y ago

Many people prefer dealing with cash and don’t want to go to the pharmacy.

helloworld11 5y ago

Your point being what? You seem to be saying: "But it's still better with insurance and in any case it's not as ideal as I'd like (as an insured person with decent insurance)" Okay, and what about the simple fact that for those people (many millions of them) who do not have insurance, or have shitty, finicky insurance, this is still a considerable possible improvement? You extrapolate your privileged position to create a whole criticism of a more viable and affordable way of buying medicine that many people outside your situation would maybe embrace because they lack the same options.