The Launch of Mark Cuban’s Cost Plus Drug Company May Come With a Price for US Health Care

In August 2018, I wrote a commentary entitled “The Launch of Amazon’s Online Pharmacy May Come With a Price for US Health Care.” Now I will focus similarly on the launch of Mark Cuban’s Cost Plus Drug Company.^1-3

This new service will sell generic drugs, that Mr Cuban says “will bypass middlemen and outrageous markups.”¹ This company will not accept health insurance. Mr Cuban states there will be a 15% markup plus a dispensing fee.³ Everyone applauds the effort of this new distribution system to lower the costs of drugs. However, will this improve health care for the average US citizen?

Will Cost Plus Drug Company reduce medication errors that contribute to substantial morbidity and mortality in the United States? Probably not. The rate of drug-related errors is a major health care crisis.^4-6

The annual estimated cost of drug-related morbidity and mortality resulting from nonoptimization of medication therapy is $528.4 billion (range: $495.3 billion-$672.7 billion).⁵ This estimated annual cost is equivalent to 16% of total US health care expenditures in 2016. The average drug-related morbidity and mortality cost was $2481/event (range: $2233-$2742).⁵ For every prescription written in the United States, the estimated cost of drug-related errors is approximately $15.

Will this new company check to make sure new medication will not interfere with a patient’s current medications? How will this company know what branded medications the patient is taking?

Cost Plus Drug Company will screen for potential problematic one-on-one drug interactions for consumers. This is laudatory, but the health care system has claimed this service for years, and yet drug errors continue to escalate, injuring an estimated 1.5 million persons yearly.⁷

Medication errors include choosing the incorrect medication after typing in the first letters of the drug name, choosing an incorrect frequency, filling the prescription inaccurately, or the patient not taking the medication as prescribed. Pharmacists, working with physicians, can influence this crisis in a very positive manner. Cost Plus Drug Cost Company’s service does not appear to improve any of these poor outcomes. Cost Plus Drug Company will have to prove, in short order, they actually can affect this major health care crisis.

Will Cost Plus Drug Company improve medication adherence? Possibly. By improving convenience and potentially making drug pricing more competitive, medication adherence can be improved.¹¹ This is what the Cost Plus Drug Company website claims.³

However, this promise could easily become a major problem if local community pharmacies close because of their inability to compete. The loss of community pharmacies seems to have occurred after Amazon’s launch into drug distribution. Will Cost Plus Drug Company add to the demise of more community pharmacies? Probably, and perhaps at a faster rate, thereby exacerbating the medication adherence problem instead. This issue should be followed closely by the health care industry.

Additionally, it is clear that structural inequality due to social and environmental factors limits quality health care access in the United States.⁸ Community pharmacies are a mainstay in delivering care in some marginalized communities. Further loss of community pharmacies will not improve racial inequality in health care, and may, in fact, exacerbate this structural problem.

Prescribing inertia in many diseases remains a significant problem across the world.^9-11 Ineffective or potentially harmful treatments are often not stopped, even years after they have been started, and effective treatments are too often not started.¹⁶ Cost Plus Drug Company will not affect prescribing inertia.

Finally, waste in the US health care system ranges between $760 billion-$935 billion, or approximately 25% of total health care spending.¹² This waste is related to failure of care delivery, failure of care coordination, overtreatment or low-value care, pricing failure, fraud and abuse, and administrative complexity,¹³ so Cost Plus Drug Company will not affect the health care expenditure problem.

Therefore, before the US health care system welcomes Cost Plus Drug Company with open arms, we should consider all the drug use processes that are involved in providing excellent pharmaceutical care to the patient, beyond just drug distribution.

References:

1. Hernandez J. Billionaire Mark Cuban launches online pharmacy aimed at lowering generic drug prices. NPR. Accessed February 3, 2022. www.npr.org/2022/01/24/1075344246/mark-cuban-pharmacy
2. Brodwin E. Mark Cuban launches digital pharmacy promising steep discounts on generic drugs. Axios. Accessed February 3, 2022. https://www.axios.com/mark-cuban-online-pharmacy-2f3078ea-2f85-4152-a8d1-d4e1942f5eb7.html
3. CostPlus Drug Company. Accessed February 3, 2022. https://costplusdrugs.com/
4. Kohn LT, Corrigan JM, Donaldson MS, eds. Errors in health care: a leading cause of death and injury. In: Kohn LT, Corrigan JM, Donaldson MS, eds. To Err is Human: Building a Safer Health System. National Academies Press (US); 2000. https://www.ncbi.nlm.nih.gov/books/NBK225187/
5. Watanabe JH, McInnis T, Hirsch JD. The cost of prescription drug-related morbidity and mortality. Ann Pharmacother.  2018;52(9);829-837. doi:10.1177/1060028018765159
6. Assiri GA, Shebl NA, Mahmoud MA, et al. What is the epidemiology of medication errors, error-related adverse events and risk factors for errors in adults managed in community care contexts? A systematic review of international literature. BMJ Open. 2018;8(5):e019101. doi:10.1136/bmjopen-2017-019101
7. Medication errors injure 1.5 million people and cost billions of dollars annually; report offers comprehensive strategies for reducing drug-related mistakes. News release. National Academy of Sciences; July 20, 2006. https://www.nationalacademies.org/news/2006/07/medication-errors-injure-one-point-five-million-people-and-cost-billions-of-dollars-annually-report-offers-comprehensive-strategies-for-reducing-drug-related-mistakes
8. Prescription drug price transparency and its visible impact on medication adherence. DrFirst. Accessed February 3, 2022. https://drfirst.com/resources/blog/prescription-drug-price-transparency-and-its-visible-impact-on-medication-adherence/
9. Williams DR, Cooper LA. COVID-19 and health equity—a new kind of “herd immunity.” JAMA 2020;323(24):2478-2480. doi:10.1001/jama.2020.8051
10. Roumie CL, Elasy TA, Wallston KA, et al. Clinical inertia: a common barrier to changing provider prescribing behavior. Jt Comm J Qual Patient Saf. 2007;33(5):277-285. doi:10.1016/s1553-7250(07)33032-8
11. Zoler ML. Experts tout immediate quadruple therapy for HfrEF patients. Medscape. Accessed February 3, 2022. https://www.medscape.com/viewarticle/939465?src=soc_tw_201022_mscpedt_news_tho_hf&faf=1
12. Steinman MA, Landefeld CS. Overcoming inertia to improve medication use and deprescribing. JAMA. 2018;320(18):1867-1869. doi:10.1001/jama.2018.16473
13. Shrank WH, Rogstad TL, Parekh N. Waste in the US health care system: estimated costs and potential for savings. JAMA. 2019;322(15):1501-1509. doi:10.1001/jama.2019.13978