When Elon Musk went on X to ask why Americans aren’t “getting their money’s worth” even though the United States leads the world in health care costs, Mark Cuban stepped in with some hard truths. Cuban, known for his outspokenness and immersion in health care reform, gave Musk and other CEOs a crash course in how their decisions affect the cost of health care in the US.
“What’s important are the contracts private company leaders sign,” Cuban wrote in response to Musk’s tweet. He explained that many of these contracts, especially with Pharmacy Benefit Managers (PBMs), are at the root of inflation and mismanagement.
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Cuban outlined seven major PBM deals that affect not only companies like Musk’s Tesla and SpaceX but also employees and their families:
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No control over claims data: Companies do not have full access to the data about what is being charged or paid.
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Restricted formularies: PBMs control which drugs are covered, often prioritizing profit over health.
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Extreme “Specialty Drugs”: These are often labeled without reason.
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Reimbursements come at a cost: “Refunds” paid by pharmaceutical companies ultimately increase co-pays and co-pays, hitting the sickest and the elderly hardest.
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Hurting independent pharmacies: PBMs often reimburse small pharmacies less than the cost of brand name drugs, driving many out of business.
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No manufacturer affiliation: Companies cannot work directly with drug manufacturers to develop targeted health programs.
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Opaque Agreements: Many PBM agreements include NDAs, making the system ineffective and increasing costs across the country.