Trolling? I was making a genuine observation. I wasn’t aware that Cuban was a supporter of many of Trump’s initiatives like this, but perhaps he was.
I was just pointing out what I thought was an objective observation that a business person opposed politician working towards {thing x} and then suddenly emerged with a business doing {thing x} once the potential public sector competition was out of the way.
But of course this assumes a degree of pessimistic motivation from Cuban. Given how often these kinds of motivations are assumed of people who challenge a public sector solution, I didn’t think to justify that assumption much, but I can see now how not doing so might have come across as trollish.
while its sleazy to not be forthcoming, I've a feeling in general a private competition is better than a US gov. Sometimes it's hard to create right private marketplaces, and healthcare is one of those areas.
Trump Derangement Syndrome. Not liking Trump or his policies is one thing but people with "TDS" make him a central part of their identity and constantly look for ways to work their hatred of him into every situation.
> ... but people with "TDS" make him a central part of their identity ...
What do you call people who make Trump a central part of their identity and constantly look for ways to work their hatred of Biden/Democrats in to every situation?
Is BDS a thing yet? I've never considered the current occupant of the hot seat to be particularly controversial, but based on the volume of FJB and LGB comments, maybe TDS/BDS are expected mirror images with a similar root cause.
You characterize anyone who uses the phrase "Trump Derangement Syndrome" / "TDS" as an extremist? I suppose most of my friends and family are extremists then, under your definition?
When you use language like this, it dilutes the meaning of the words.
Somewhere around half of the country generally vote for the "right". A significant portion of those folks have use the TDS phrase, to point out an observable phenomenon, of certain high profile people acting in abnormal ways when reacting to Trump.
You are labeling these people "extremists"?
How would you characterize militant racist militias that are (in relatively small numbers) scattered across the country?
Would you lump these people all together under the "extremist" banner?
I've yet to hear a person use that term who couldn't be described in that manner. When considering the full breadth of modern Western thought, please describe for me how the people who use that language don't fall on the extreme end of the political spectrum. I never used the word "militant." I used the word extremist. The term fits.
Yes, people generally have a strong reaction when talking about the sort of low-quality human being that Trump proved to be. That's not a "derangement syndrome." That's called having a sense of humanity and self-awareness.
Nah it’s simple derangement. Anyway I’m glad we can dehumanize our political opponents freely. It took a lot of doing but the other side is no longer even people. We’re almost there.
One of the highlights of 2021 for me was watching him lose millions as one of the "stablecoins" he promoted dumped from $1 to 0, and then going on Twitter to rant about crypto.
I don't respect Cuban in a business context because he only wants credit for wins, not losses. But I also don't know what TDS is after a solid 60 seconds, so maybe I'm not one who should be commenting... but I'm going to write about him anyways.
"Grifter" is not how I'd describe Mark.
Grifter is a term I'd use more with someone like Trump, who doesn't seem to even attempt to make good decisions and lacks altruism.
For example, I sincerely enjoyed that Mark funded that stupid patents thing at the one place years ago, though I'm typing from memory and thus lack the abilty to give a specific citation.
I don't have a ton of capital, but I respect that not everything can come via public funds, and that it's good to give folks the option of donating to organizations they are fond of. (I like to half-jokingly call this "venture socialism" -- the joke being it's more about a smart person choosing to give, rather than the amount, but unfortunately that Signal, like many before it, has been detected and abused by bad actors.)
For example, I'm not a Buffy fan -- it was popular during the VCR era and when piracy was more difficult. So I made a purposeful choice to never enter the fandom and let folks enjoy the spaces for it, on and offline. (Well, that and one of my exes is a huge Buffy Fan, and I simply don't want to run into her without a heads up, and the easiest way to do that is avoid Buffy conventions or any adjacent crap at all costs.)
Along similar lines, even if he ends up being a texting buddy, I'm not gonna hit him up for super bowl tickets, because I don't think I'd enjoy it and there are limited slots for physical events.
Anyways TL;DR: he's not a grifter, just narcissistic and in possession of a bankroll and social network that allows him to make more errors than most folks while maintaining a large following.
If you're referring to the executive order the previous president issued in Sept 2020, you're only partially correct.
Yes, he ordered HHS to research alternative pricing models. But, the statutory ability to do so was granted by the ACA which the administration and party spent the entire term attempting to overturn, taking it as far as SCOTUS. And HHS eventually declined to implement any changes.
This keeps showing up but it's total bullshit. Cuban wants to take 15% of the transaction for running a web site and processing payment. They're not manufacturing drugs. They're not buying drugs. They're not shipping drugs. They're not doing anything at all besides taking your order and giving it to someone to do all those things.
It's not a charity. It's a profitable business and a very profitable one at that.
Oh yeah, and the prices aren't lower than what you can get using GoodRX.
From one of those prior discussions, a related nonprofit effort to lower prices of drugs that are sometimes in short supply or overpriced, where the founding Utah hospital system has joined with other hospital systems, has a solid, long-term reputation (and good personal experience--their intake agreement to get a blood sample drawn totaled 2 reasonable pages, where the next-nearest hospital came out at 11) and have generally done friendly good work for a long time as far as I can tell.
Wikipedia said (lightly shortened): "Civica Rx is a nonprofit generic drug company founded in 2018 by national philanthropies and leading U.S. health systems[1] to reduce and prevent drug shortages in the United States and the price spikes that can accompany them. .... While serving 55 health systems and 1,500 hospitals (or 1/3 of all licensed U.S. hospital beds), Civica also supplies the U.S. Department of Veterans Affairs, the U.S. Department of Defense, and “340B” hospitals caring for vulnerable patients in some of the country’s most underserved areas. As of January 2022, Civica provided nearly 70 million vials of essential medicines, enough to treat over 26 million patients across the United States. These numbers continue to grow as Civica moves from a start-up to a well-established societal asset, serving more patients every day. Most recently, eleven of Civica's 55+ medications are being used to help COVID-19 patients, including neuromuscular blocking agents, sedation agents and pain management medications for patients on ventilators."
Etc. ( https://en.wikipedia.org/wiki/Civica_Rx )
I've done work in this industry. Negotiating wholesale contracts and contracts directly with manufactures as well as all the other middle men. In theory alone, Cuban's strategy should/could work. However, what I've seen is there is a market price equilibrium effect in place such than any middle man who is best positioned, will inflate the price towards that market price. So what will happen is, in a world where it's only the manufacturers and Cuban, the manufacturers will get to absorb all the profit of the current middlemen and Cuban keeps his 15% and the price to consumers remains. Or, continues upwards seeking that equilibrium point. For generics, there may be some competition and the market of manufacturers will naturally consolidate until the generic is only available from a single manufacturer. In many instances, this already occurs, the manufacturer has a Brand then when IP is open and competition imminent, they release the first Generic at a price that makes other manufactures hesitant to ramp up production thus maintaining a complete monopoly for that specific drug.
And then you realize this is simply how capitalism is designed to work. People in the business of healthcare always try to dream up these complicated business models and because the other complicated business models inflate prices and their new and better business model is going to save the world. It almost never happens or works. Capitalism and the set of basic economic laws win every time.
The only real solution I could dream up is to implement price control. Where the consumer's cost is some function of the manufacturer's cost. Where the function/regulators should discourage price gouging and encourage manufacturing efficiencies. Unnecessary costs like mass advertising campaigns should be banned and the R&D side of the business should be separated from the the sales side. I personally wish all the IP generated in medicine was somehow publicly owned; either through purchase, initial funding, or... IDK I just think it would benefit all by having the scientific side of medicine unrestrained from IP.
FWIW, I'm pro-capitalism but don't feel it should be universal. Healthcare deserves a universal approach with a goal of maximizing access and thus affordability. And, I say that having personally built a decent career on the business end of healthcare that would likely evaporate if healthcare was truly "fixed" and I would completely accept that fate for the greater good.
"the market of manufacturers will naturally consolidate until the generic is only available from a single manufacturer."
That's called a monopoly. And while it is a natural tendency it's also a point of regulation. By preventing monopoly you keep the desirable part of capitalism (competition) without having to enforce less palatable anti-capitalist measures like direct price controls.
Agree and I believe I called it an effective monopoly following that quote.
But, it's simply not regulated today. You'd have a hard time proving they are pricing in this way as a means to hold the monopoly. They could point to their margins and say, "plenty of room for competition" but meanwhile you can't force other manufacturers to ramp up production without even fatter margins. They'd need margin + market share to break even.
It usually only when the market is very large, manufacturing is not complex, or when the original manufacturer is still charging a lot for generic (sometimes only a bit lower than Brand). That another manufacturer will ramp up production. Often times, even manufacturing a generic drug requires steep initial investment and can be risky.
Even for generics with multiple manufactures, "multiple" might be only a handful. When you compare that fact, to the pricing trends they follow, it then is an effective oligopoly. And while I don't believe it to be the case, the pricing trends I've seen sure do look like collusion. My experience is it's more like an indirect collusion, where company A employs folks that have worked for competitors A, B, and C. So when they hear "through the grapevine" that company B is going to increase prices 10% next quarter, suddenly everyone is increasing prices 10% next quarter (give or take). [This I've witnessed myself a number of times]
Take this honest question in the spirit it was intended because I agree with everything you posted and appreciate both your candor and ethical stance.
You mentioned "access" and "affordability" but there is a third leg of healthcare in terms of "quality". How do you see your proposed approach affecting healthcare quality?
For example, does public-owned R&D lower incentives to generate new treatments? Or, conversely, does it raise incentives for higher quality drugs for underserved (and unprofitable) diseases?
Yeah, great questions actually. Not sure I have a fully formed model I'm putting forth so just going to speak in generalities.
> How do you see your proposed approach affecting healthcare quality?
In the business end of healthcare, quality is just a base assumption. You (Okay most) would never make a business decision that erodes quality and clinicians are trying to improve quality all the time. The companies I've worked for have entire departments named simply "Quality" with significant budgets/headcount. That said, from an economic standpoint, it just needs to be a part of that formula. The current real thing that comes to mind is CMS (Medicare) issues quality scores to hospitals (star ratings) and their reimbursements go down if their quality score dips. It also helps folks "shop" providers as the star rating is public information.
> does public-owned R&D lower incentives to generate new treatments?
I don't think it has to. Scientist want to do science. If funded, I believe they will. I'm more concerned with what science we're ignoring because it has no obvious GTM strategy, link to some ROI, &/ random business objective.
> Or, conversely, does it raise incentives for higher quality drugs for underserved (and unprofitable) diseases?
I think it does, or can. Because I think it opens the field for more exploration. I've never been very close to how pharma R&D is performed, but my understanding is it's rather narrow. For example, "we want to solve X because we can make $Y". Once we solve X, we can do X.a, X.b, X.c, etc. It doesn't matter that they could make the world a better place by solving Z and perhaps that's what the scientist would rather be doing.
I'd certainly entertain counter-arguements, this is just Sim City brain at work on hypothetical realities.
>I think it does, or can. Because I think it opens the field for more exploration.
I somewhat disagree. I think the best solution is for payers (single or not) to set prices based on quality adjusted life years (QALY). This is done in some single payer markets and makes a lot of sense as it couples incentives with impact.
While cooperate Pharma pays most of R&D costs, Fundamental (extremely early) research is usually still publicly funded through academia. This is where the possible solutions to Z come from.
The "problem" is that R&D spend can have more impact (lives saved) on mainstream diseases than rare diseases. Public-funding/ownership doesn't solve this fundamental issue. You can direct funding to rare diseases by decree, but you are still saving fewer lives than you would otherwise.
Either approach would be an improvement to current format. My only issue, and I'm rather layman on this, is I don't think academia creates solutions. They generate ideas and the pharma has to figure out all the parts to manufacture/commercialize it. I'd think that process could be more seamless. Right now, I think academia may touch on Z but if there's no $ it just dies in academia and that's a shame.
I also tend to agree that we should be solving problems that affect folks the most and factoring for the magnitude of the issue which is what QALY seems to do to gauge impact, so I like that idea. However, in doing so, I expect you're casting a larger net and bound to stumble on something that serves a smaller market as a byproduct of the R&D. In the current reality, the byproduct would get shelved and never commercialized because it had no ROI, which is also a shame.
Side question: I had some vague notion that Cuban was getting into the mfg side. Like maybe white labeling specific drugs he bought from existing mfgs, possibly even generic. Like Amazon Basic, but for drugs.
Which is how I assumed Amazon was going to enter the pharma space. But what do I know?
Any way, would such a move much change your analysis?
PS: I distinguish market capitalism and corporatism. One is pro competition, the other is utterly opposed to it.
The white label approach is exactly the case I hypothesized (world with only manufacturers and Cuban), so no change there. I believe it's called "white label DTP direct to patient". This is picking up steam in the industry. It could certainly work and could compete against the status-quo for a time; but as it scales in market share, I anticipate the economic forces I described to eventually occur.
If he begins manufacturing the products, I'm not sure how that works. But I believe there's a lot of regulations and issues around manufacturer-to-patient sales. Tides could be turning, my experience in this part of healthcare is a few years old now. In theory, I suppose Cuban could stand up a separate legal entity for manufacturing where he sells to his pharmacy legal entity at some low price to avoid the economic forces I described.
Sorry, I misread. Further, OC explicitly says "Truepill is a white-labelled pharmacy e-commerce platform that MCCPDC".
I should have read more closely. I think part of my confusion is from not seeing (or maybe not recognizing) any examples on costplusdrugs.com.
Regardless, your points about retail price equilibrium still stands.
The choices remain "hollywood accounting" (fraud) and price controls. I continue to hope there's a third option. Not for any moral reason. But rather to avoid the inevitable omgherd libertarian backlash about the authoritarian governmental depriving corporations their god given right to further impoverish sick people. Something like changing the market incentives from fee-for-service to rewarding wellness (eg capitation). But I have yet to imagine how that could work for pharma.
Anyhoo. Thanks for humoring my grasping at straws.
It's not total bullshit - compare Imatinib on GoodRX ($787) vs CostPlus ($14) for 30 tablets. What the company is doing is cutting out the (arbitrary) pharmacy markup. They take a 15% cut and are TRANSPARENT about their price (again, novel in the drug industry). If you followed their company, you'd also notice they have plans to further lower the margin by manufacturing their own drugs, but these things take time.
GoodRX shows me $42.54 at Publix vs $19.40 shipped from CostPlus. So yes, some drugs will be cheaper but it's not the magnitude of savings they claim and it's not across the board. Last time this came up I checked a handful and CostPlus was usually slightly more when you include shipping cost.
> but it's not the magnitude of savings they claim
I follow Cuban on Twitter and he retweets people constantly who are saving substantial amounts of money. In their own words the savings are huge. Are you claiming these people are lying or fake?
People likely are saving a ton of money, but they were also probably not utilizing the most optimal solution out there previously (e.g. buying through their insurance vs. GoodRX).
Right, so this is a big win for awareness. I've heard of GoodRX a few times but never looked into it because I have decent insurance. It took Mark's new venture, and his marketing efforts (via Twitter) for me to realize "this was a thing".
Sure, but it's not getting rid of middlemen or making anything more efficient. It's just another actor sliding into the market to make a bunch of money exploiting the broken drug market.
It saves pharma consumers money between now and when US healthcare is “fixed” (whatever that looks like), which could still take a long time. As the starfish parable goes, it matters to these people. I encourage you to recognize that reduction in suffering and economic hardship in the short term.
Yeah, I really disagree with the person above you, @treis. This saves people money. It's not stealing from them, it's saving them money. This is a valuable and good thing. This gives attention to the fact that they can pay much less.
The people doing valuable work are Truepill that's actually doing the heavy lifting of fulfillment. Cuban is slapping his name on a white label solution, taking 15% for his trouble, and acting like he's solving the US health care system. In reality, he's just another middleman inflating prices.
If many drugs are cheaper... what's the complaint then? That it's not as much saving as they say? At the end of the day, the market will speak. If he's cheaper than the market and people start buying from him, then its a net positive for everyone.
I think the complaint is this isn't a new or unique solution, but it already exists through other companies like GoodRx.
Just out of curiosity, I looked at some of the costs for the most prescribed meds. All seemed to within the same price range. Personally, I liked the GoodRx UI better.
Not that what Cuban is doing is "bad" but I don't know that it needs to be characterized as some radical new alternative. That seems more like marketing hype to me but it does a good job of raising awareness.
If it’s cheaper, why does it have to be a radical alternative? The healthcare system is so screwed up that simple solutions / “low hanging fruit” are available to be implemented. For example, allowing government prescription purchases to be negotiated, which a rational person would deem basic, but it is presented as a draconian act against insurance companies to allow it.
It doesn’t have to be radical to be useful. I think what Cuban is proposing is useful. It’s just not radically better than other options that already exist, so from that perspective calling it unique or novel or radical is mainly marketing hype.
How is not a net good? Are you saying that a 50% saving is not significant enough reduction in cost? Certainly this is a step in the right direction? I get that Cuban putting his name on an existing project is kind of annoying but it's certainly good PR for the company, right?
The reaction to his company is weird. It's not a charity, and I don't think he claims its a charity. We have plenty of charities the deal with healthcare and plenty of non-profit hospitals. Doesn't really do much in the grand scheme of things. He wants to lower price the same way Bezos wants to lower price. Your margin is my opportunity.
Why do you have this reaction to just this particular business? Do you have it for other businesses? Like a low-cost supermarket opens up and you're upset that they're not really growing their own food? At this point, I would applaud any competition in the US health care space, especially if it adds transparency.
Objective analysis. Cuban, Musk, and others have developed fandoms yielding coverage that portrays them as 'saints' (an overly positive light). With fandoms comes some degree of polarization as non-fans present their counter-points.
Cuban found there is margin that can be squeezed in the pharma market due to being a high margin product with inefficient distribution. He moved on a revenue opportunity, plain and simple.
Fans can certainly do the inverse with a mild evil and exaggerating it into a great good, I just don't think it is the case with Cuban's option for low price drugs. It is hard to follow the mental gymnastics that twist people getting a cheaper option to buy drugs into evil, even if it isn't perfect. The worst possible outcome is the drugs aren't cheap and people don't buy them. No harm, no foul.
Regarding Musk's loop and Boring company, I would also consider those a mild good. Hyped to high hell, but I don't see how that ever becomes bad.
What is awful about cheaper all electric tunneling rigs? If if meets some of the claims, then cool, if it doesn't, then it is neutral.
I am honestly curious why you think it is pretty awful?
Hm I don’t know about tunneling rigs. I assume that’s one of their own made things for their tunnels? A search only shows a couple of things about that and it appears to be all internal stuff. Nothing for the public or to be sold to businesses.
One major issue with their rigs would be the future impact of their tiny tunneling. They tunnel such small holes that make the actual end products weak. Their Vegas tunnel are so small. God forbid there’s an emergency while there’s a lot of traffic. Good chance lives will be lost.
Vs the amount of results for their main product they’ve done and sold that isn’t a blow torch: the Vegas loop. That’s what I was talking about. It seems to be an awful idea that is widely seen as a disappointment now. Their LA plan was by far much stupider. They were trying to do a tiny fraction of the traffic that an electric underground metro could do while being much less energy efficient since trains are more efficient than a lot of cars.
There’s a boatload of issues that make the tunnel awful and nothing more than a way to push Teslas more. All I can find are negative takes of the Vegas loop. I can’t add anything others aren’t saying.
It’s hard for me to see how the entire thing isn’t a scam to push Tesla. It’s mine boggling that this isn’t getting the same treatment as Morbius the film (intense loud continuous mockery). Then I remember the insane amount of fans and the push to keep everything Elon positive.
I appreciate you calling out some, let's call them un-nicities, that aren't usually spelled out when this comes out.
All of that said, I don't think that makes the idea BS. The company is able to save many people money on prescriptions, which is a good thing. That Cuban or his company makes money on the way shouldn't bother us in the least (unless/until we ever get single payer).
>> This keeps showing up but it's total bullshit. Cuban wants to take 15% of the transaction for running a web site and processing payment.
If he saves the consumer a lot of money, does it really matter if he takes 15% of the txn? Secondly, dont people/companies deserve to be paid for value they add?
My US-specific experience is that customers are squeezed for a pound of flesh. These often come at the worst time, when you are sick, possibly really really sick. For example, you're deathly ill, on line at CSV, and you're arguing about a $200 mystery co-pay for a prescription you cant wait days for. Luckily for me as a SWE, I can afford $200 mystery charges. For some it could mean death.
Any way to create transparency of pricing is really important, and could lead to live and death moments. I dont think we should dismiss these lightly.
Are you hating just to hate,I just looked up a prescription that is for adhd/depression generic variant and its $399 at GeniusRx minimum and $15 shipped at Cost Plus.
They must be doing something right and a lot better than someone commenting on their buisness model whereas you dont even know other pharmacies inefficiencies/model.
Thw whole article is about reducing costs through "simplification" and "removing the middleman". If anyone else thinks that laws,disttibution oligoololies and lobbies are not the problem, they can go build a drug factory and see if that works out. Drugs are produced cheaply and can be distributed cheaply from other countries in the US tomorrow.
I can't count how many articles about X company or investor is addressing this issue and I don't think anyone has solved it.
I can't find any magic numbers here that explains how the proposal here to replace the "middleman" lowers prices ... by just being another middleman...
Admittedly I don’t know a ton about Mark Cuban, other than he kinda seems like a simpleton.
But if he’s able to have a profitable drug company that doesn’t produce drugs that lowers costs for consumers.. Welp that kinda shows that the system is in need of some change.
Good on this company for helping that though. Hopefully the clever people in the industry take notice and further improve things.
He's probably just buying them wholesale and setting a fixed profit margin.
Color me shocked if it ends up harming independent pharmacists, though... and I say that as someone who thinks universal healthcare is the way to go in the US. Wonder how long before he decides to sell this company to Walmart.
Those of us who have forgotten how Walmart decimated middle America are doomed to repeat it.
It's a good thing that people will receive drugs at low prices, but most drug companies have programs to deliver them for low prices anyway. When those local pharmacies die, then large companies will step in and jack up the costs anyway. And if you don't believe that Cuban would sell that company, then you haven't paid attention to his history. The man is many things, but altruistic isn't one of them.
I totally respect the earned media game. A+ marketing.
The actual business (so far) is pretty straight-forward:
1. Call an API to TruePill pharmacy
2. They fill it under the Costplus label and mail it.
3. Cost of drug is acquisition + a small markup that Costplus and Truepill share
4. Display the Truepill API fields in a NEXT.js website
I totally respect Truepill operational chops too. Pharmacy is a very tough business.
I am waiting for someone to figure out how to break the PBMs pricing-power (monoply-like) control over that business. That would be the true breakthrough. Maybe it would be costplus in a pivot. Or a regulatory change.
Also - I deal with CivicaRX in a daily basis. It is a valiant attempt, but they have major shortcomings.
FYI:
If someone wants an API that really tells how much drug costs. (trust, but verify!)
User acquisition is a big thing. There are loads of people (including doctors) who lean on brand name drugs when generics are available and it's largely about that brand. Drug names are obscure and drug brands become trusted. If Cuban can successfully build a brand with a lot of awareness then that has the potential to uplift the entire generics market. Even if the actual mechanics of the business are nothing special.
1. Your insurance can and will block certain pharmacies if they got big enough (see PillPack before the Amazon acquisition). They have their own pharmacies and route the most profitable scripts there.
2. You would run into market size limitation if you decide to never accept insurance
3. Getting someone to switch their pharmacy requires major effort on their part - as well as the cooperation of all their doctors. It's almost like switching IT vendors!!
Yeah it's all over Reddit too. I can't wait to read all about it in Ad Age and MM+M. It's a good campaign...burnishes Cuban's image while building the brand.
I think you underestimate the number of people who don't realize that "drug drop shipping" is a thing. In the US at least, you go to your doctor, they send your prescriptions to your local pharmacy, and then you hope/pray it's cheap (depending on your insurance) when you go pick it up. There is no discussion of "where" to send them and what is an "affordable" pharmacy vs "expensive".
Is my local CVS an "expensive pharmacy"? No clue, but before Cuban's website I didn't even consider that these type of businesses could help lower my drug costs even below what I pay WITH insurance.
There's also a huge disconnect between people who occasionally need prescriptions, and those that rely on prescription medication daily. If you get one script a year it probably doesn't matter, but if your disease requires a drug that costs $5K/month, you get very informed, very fast.
Except I work in industry, both specialty and retail pharmacies.
For any chronic disease (the ones this program benefits most), most doctors will get you setup with the cheapest option for your insurance / PBM. As cost of treatment is the #4 indicator whether people will fall off treatment in the United States[1]. Additionally, in a retrospective study, cost was cited as the main reason for non-adherence in 17% of cases, making it the #3 leading cause[2]. This number is as high as 55% depending on age / demographic... Doctors working in chronic diseases know this and have to deal with it like any other adherence issue.
For one off treatments, people usually just go to their grocery store or local pharmacy.
Are there patients who are over paying? Absolutely. Is this a cash grab by a multi-billionaire because its not actually addressing the issues resulting in expensive drugs? Absolutely.
Your response is quite confusing. On one hand, you’re proving my point that consumers are overpaying regularly. Medicine prices are a meme at this point, and if it were easily solved we wouldn’t hear about it as leading causes for non-adherence.
> Are there patients who are over paying? Absolutely
But then, you dismiss all of that by implying this is a useless exercise because patients who need low cost meds are getting them.
Good luck actually being able to use it. The biggest problem I have I being forced into using CVS because the insurance side has merged with the pharmacy side and requires that I use their services for most things. On a side note, the service quality they provide is terrible and they have repeatedly sent me false information regarding my family's prescriptions.
The insurance companies are one of the main problems. It sounds like this doesn't solve that.
This is absolutely baffling to me. I live in the UK and was given a non-NHS prescription after a diagnosis for ADHD, and a month's medication is £13. Why are pharmaceuticals in the US so expensive?
Some are. The latest and greatest are. Generic medications are often inexpensive or free (with insurance). I take 4 regular medications, one has a cost...with my insurance it’s $7 a month ($25 without). 3 are free insurance or not because my grocery/pharmacy provides them for free because the want me to buy their inflated grocery prices instead of going across the road to spend my money at their competitors.
In the UK for people on low or no incomes or people under or over certain ages all prescription drugs are free and for everyone else they are a fixed charge per item (usually 9.35GBP). This is regardless of whether they are the latest and greatest or a generic.
Mark Cuban is not solving ANYTHING. Can we please stop worshipping billionaires who got extremely lucky during market bubbles? I think Kim Kardashian has a better chance of fixing the drug prices.
The first article includes this snippet: "If there is reason for optimism, though, it lies with the medical background of Oshmyansky, the company’s co-founder and CEO, according to Gewanter.
'The radiologist Cuban is working with knows the business,' Gewanter said. 'Between the two of them, it is not difficult to imagine that they will figure out where the gaps are and how to exploit them. We can only hope that when they do, our patients will be the beneficiaries.' "
I think YC made a fantastic choice including Alex's company in YC, and it's been a pleasure seeing what Alex has done and is doing. I'll stop there for now.
So he's doing everything but addressing the root problem, like every other neoliberal grifter. But worse, he's helping perpetuate the myth that the manufacturers aren't the worst actor in all of this. As if they hadn't blocked every reasonable reform that came along. Just like with guns, other countries don't have this problem, for very simple reasons. Why do people keep posting garbage like this?
And therein lies the actual problem. Far less complex systems in other countries with similar per capita GDP do not have this issue. And part of the reason they're less complex is because they don't allow a basic human need to be managed by a mostly for-profit system.
Not said with snark, but do you think you're the first person to think the system should be simplified? Do you understand that part of the reason the other systems are more simple is because they effectively rely on the U.S. healthcare system for things like R&D? It's pretty easy to create a simpler system when you can ignore certain aspects because someone else will pick up the slack.
The problem with the "simple" solutions is they often assume we start from a blank slate. Acknowledging we're not starting from a clean slate where do you propose we simplify first? And before you reply can you think about 1) how will it be done, including the political aspect and 2) what is the potential unintended blowback from that change?
Anyone checking out this should also look at GoodRx. Full disclosure, I work at GoodRx. I think we beat them on prices for the most part but it is always good to check theirs too. They beat our prices sometimes.
I am all for picking whatever the lowest price is. That is the whole goal.
If it's not insurance or drop shipping, what does GoodRx do that results in cheaper prescriptions for customers? For awhile, they were saving me $100/mo.
I think GoodRx has a marketing problem. I’ve heard of it but I never knew what it does. Just sounds like another pharmacy to me. An ad addressing those would go a long way. Target most sought after drugs and advertise those low prices
There was a reddit thread about this article yesterday and it was filled with people who were suddenly able to find their medication for orders of magnitude cheaper. This meant that for some it made an immediate and significant financial difference to their lives, and for others it meant access to medication they could not previously afford. In some cases reading this article was being described as "life saving".
This is very interesting but not because Cuban's business model is unique. It suggests that this group, who are probably a bit more net savvy on average, were not aware of other similar businesses like GoodRX.
This implies that there is a highly in demand product (cheap medication) but the problem is awareness, so it's a marketing challenge. Cuban is very well positioned to solve this problem by using his personal brand and tools like these PR articles.
This is a good thing! He has the brand, marketing chops and resources to drive it forward. It will increase the size of the market, meaning more people have access to life changing affordable medication. This may spawn more clones of the business model, further increasing the market size, rinse repeat. If this market gets big enough maybe it will apply pressure for change upstream? That would be a great thing.
Here on HN we are heavily weighted in our thinking towards the value of product in business (which is normally undervalued) and that is great, but examples like this reveal a real blind spot. Sometimes the value of something like marketing is forgotten or even worse dismissed. But they're extremely powerful tools when used correctly. Apply good marketing to a good product and you have Apple.
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[ 0.21 ms ] story [ 182 ms ] thread(Though only mnetaphorically, I hope... meeting people from the internet "IRL" rarely ends well in my experience.)
Stop trolling.
I was just pointing out what I thought was an objective observation that a business person opposed politician working towards {thing x} and then suddenly emerged with a business doing {thing x} once the potential public sector competition was out of the way.
But of course this assumes a degree of pessimistic motivation from Cuban. Given how often these kinds of motivations are assumed of people who challenge a public sector solution, I didn’t think to justify that assumption much, but I can see now how not doing so might have come across as trollish.
What do you call people who make Trump a central part of their identity and constantly look for ways to work their hatred of Biden/Democrats in to every situation?
You characterize anyone who uses the phrase "Trump Derangement Syndrome" / "TDS" as an extremist? I suppose most of my friends and family are extremists then, under your definition?
When you use language like this, it dilutes the meaning of the words.
Somewhere around half of the country generally vote for the "right". A significant portion of those folks have use the TDS phrase, to point out an observable phenomenon, of certain high profile people acting in abnormal ways when reacting to Trump.
You are labeling these people "extremists"?
How would you characterize militant racist militias that are (in relatively small numbers) scattered across the country?
Would you lump these people all together under the "extremist" banner?
Or maybe there's a less inflammatory approach?
Yes, people generally have a strong reaction when talking about the sort of low-quality human being that Trump proved to be. That's not a "derangement syndrome." That's called having a sense of humanity and self-awareness.
"Grifter" is not how I'd describe Mark.
Grifter is a term I'd use more with someone like Trump, who doesn't seem to even attempt to make good decisions and lacks altruism.
For example, I sincerely enjoyed that Mark funded that stupid patents thing at the one place years ago, though I'm typing from memory and thus lack the abilty to give a specific citation.
I don't have a ton of capital, but I respect that not everything can come via public funds, and that it's good to give folks the option of donating to organizations they are fond of. (I like to half-jokingly call this "venture socialism" -- the joke being it's more about a smart person choosing to give, rather than the amount, but unfortunately that Signal, like many before it, has been detected and abused by bad actors.)
For example, I'm not a Buffy fan -- it was popular during the VCR era and when piracy was more difficult. So I made a purposeful choice to never enter the fandom and let folks enjoy the spaces for it, on and offline. (Well, that and one of my exes is a huge Buffy Fan, and I simply don't want to run into her without a heads up, and the easiest way to do that is avoid Buffy conventions or any adjacent crap at all costs.)
Along similar lines, even if he ends up being a texting buddy, I'm not gonna hit him up for super bowl tickets, because I don't think I'd enjoy it and there are limited slots for physical events.
Anyways TL;DR: he's not a grifter, just narcissistic and in possession of a bankroll and social network that allows him to make more errors than most folks while maintaining a large following.
Yes, he ordered HHS to research alternative pricing models. But, the statutory ability to do so was granted by the ACA which the administration and party spent the entire term attempting to overturn, taking it as far as SCOTUS. And HHS eventually declined to implement any changes.
Summary here... https://www.americanprogress.org/article/little-late-trumps-...
It's not a charity. It's a profitable business and a very profitable one at that.
Oh yeah, and the prices aren't lower than what you can get using GoodRX.
Wikipedia said (lightly shortened): "Civica Rx is a nonprofit generic drug company founded in 2018 by national philanthropies and leading U.S. health systems[1] to reduce and prevent drug shortages in the United States and the price spikes that can accompany them. .... While serving 55 health systems and 1,500 hospitals (or 1/3 of all licensed U.S. hospital beds), Civica also supplies the U.S. Department of Veterans Affairs, the U.S. Department of Defense, and “340B” hospitals caring for vulnerable patients in some of the country’s most underserved areas. As of January 2022, Civica provided nearly 70 million vials of essential medicines, enough to treat over 26 million patients across the United States. These numbers continue to grow as Civica moves from a start-up to a well-established societal asset, serving more patients every day. Most recently, eleven of Civica's 55+ medications are being used to help COVID-19 patients, including neuromuscular blocking agents, sedation agents and pain management medications for patients on ventilators." Etc. ( https://en.wikipedia.org/wiki/Civica_Rx )
https://www.fiercehealthcare.com/hospitals-health-systems/dr... (thanks to pottertheotter in another HN link/discussion about Mark Cuban, below)
https://civicarx.org/
Other prior discussion: https://news.ycombinator.com/item?id=25932233 ("The Mark Cuban Cost Plus Drug Company" about which I don't know anything more.)
And then you realize this is simply how capitalism is designed to work. People in the business of healthcare always try to dream up these complicated business models and because the other complicated business models inflate prices and their new and better business model is going to save the world. It almost never happens or works. Capitalism and the set of basic economic laws win every time.
The only real solution I could dream up is to implement price control. Where the consumer's cost is some function of the manufacturer's cost. Where the function/regulators should discourage price gouging and encourage manufacturing efficiencies. Unnecessary costs like mass advertising campaigns should be banned and the R&D side of the business should be separated from the the sales side. I personally wish all the IP generated in medicine was somehow publicly owned; either through purchase, initial funding, or... IDK I just think it would benefit all by having the scientific side of medicine unrestrained from IP.
FWIW, I'm pro-capitalism but don't feel it should be universal. Healthcare deserves a universal approach with a goal of maximizing access and thus affordability. And, I say that having personally built a decent career on the business end of healthcare that would likely evaporate if healthcare was truly "fixed" and I would completely accept that fate for the greater good.
That's called a monopoly. And while it is a natural tendency it's also a point of regulation. By preventing monopoly you keep the desirable part of capitalism (competition) without having to enforce less palatable anti-capitalist measures like direct price controls.
But, it's simply not regulated today. You'd have a hard time proving they are pricing in this way as a means to hold the monopoly. They could point to their margins and say, "plenty of room for competition" but meanwhile you can't force other manufacturers to ramp up production without even fatter margins. They'd need margin + market share to break even.
It usually only when the market is very large, manufacturing is not complex, or when the original manufacturer is still charging a lot for generic (sometimes only a bit lower than Brand). That another manufacturer will ramp up production. Often times, even manufacturing a generic drug requires steep initial investment and can be risky.
Even for generics with multiple manufactures, "multiple" might be only a handful. When you compare that fact, to the pricing trends they follow, it then is an effective oligopoly. And while I don't believe it to be the case, the pricing trends I've seen sure do look like collusion. My experience is it's more like an indirect collusion, where company A employs folks that have worked for competitors A, B, and C. So when they hear "through the grapevine" that company B is going to increase prices 10% next quarter, suddenly everyone is increasing prices 10% next quarter (give or take). [This I've witnessed myself a number of times]
You mentioned "access" and "affordability" but there is a third leg of healthcare in terms of "quality". How do you see your proposed approach affecting healthcare quality?
For example, does public-owned R&D lower incentives to generate new treatments? Or, conversely, does it raise incentives for higher quality drugs for underserved (and unprofitable) diseases?
> How do you see your proposed approach affecting healthcare quality?
In the business end of healthcare, quality is just a base assumption. You (Okay most) would never make a business decision that erodes quality and clinicians are trying to improve quality all the time. The companies I've worked for have entire departments named simply "Quality" with significant budgets/headcount. That said, from an economic standpoint, it just needs to be a part of that formula. The current real thing that comes to mind is CMS (Medicare) issues quality scores to hospitals (star ratings) and their reimbursements go down if their quality score dips. It also helps folks "shop" providers as the star rating is public information.
> does public-owned R&D lower incentives to generate new treatments?
I don't think it has to. Scientist want to do science. If funded, I believe they will. I'm more concerned with what science we're ignoring because it has no obvious GTM strategy, link to some ROI, &/ random business objective.
> Or, conversely, does it raise incentives for higher quality drugs for underserved (and unprofitable) diseases?
I think it does, or can. Because I think it opens the field for more exploration. I've never been very close to how pharma R&D is performed, but my understanding is it's rather narrow. For example, "we want to solve X because we can make $Y". Once we solve X, we can do X.a, X.b, X.c, etc. It doesn't matter that they could make the world a better place by solving Z and perhaps that's what the scientist would rather be doing.
I'd certainly entertain counter-arguements, this is just Sim City brain at work on hypothetical realities.
I somewhat disagree. I think the best solution is for payers (single or not) to set prices based on quality adjusted life years (QALY). This is done in some single payer markets and makes a lot of sense as it couples incentives with impact.
While cooperate Pharma pays most of R&D costs, Fundamental (extremely early) research is usually still publicly funded through academia. This is where the possible solutions to Z come from.
The "problem" is that R&D spend can have more impact (lives saved) on mainstream diseases than rare diseases. Public-funding/ownership doesn't solve this fundamental issue. You can direct funding to rare diseases by decree, but you are still saving fewer lives than you would otherwise.
I also tend to agree that we should be solving problems that affect folks the most and factoring for the magnitude of the issue which is what QALY seems to do to gauge impact, so I like that idea. However, in doing so, I expect you're casting a larger net and bound to stumble on something that serves a smaller market as a byproduct of the R&D. In the current reality, the byproduct would get shelved and never commercialized because it had no ROI, which is also a shame.
Which is how I assumed Amazon was going to enter the pharma space. But what do I know?
Any way, would such a move much change your analysis?
PS: I distinguish market capitalism and corporatism. One is pro competition, the other is utterly opposed to it.
If he begins manufacturing the products, I'm not sure how that works. But I believe there's a lot of regulations and issues around manufacturer-to-patient sales. Tides could be turning, my experience in this part of healthcare is a few years old now. In theory, I suppose Cuban could stand up a separate legal entity for manufacturing where he sells to his pharmacy legal entity at some low price to avoid the economic forces I described.
Sorry, I misread. Further, OC explicitly says "Truepill is a white-labelled pharmacy e-commerce platform that MCCPDC".
I should have read more closely. I think part of my confusion is from not seeing (or maybe not recognizing) any examples on costplusdrugs.com.
Regardless, your points about retail price equilibrium still stands.
The choices remain "hollywood accounting" (fraud) and price controls. I continue to hope there's a third option. Not for any moral reason. But rather to avoid the inevitable omgherd libertarian backlash about the authoritarian governmental depriving corporations their god given right to further impoverish sick people. Something like changing the market incentives from fee-for-service to rewarding wellness (eg capitation). But I have yet to imagine how that could work for pharma.
Anyhoo. Thanks for humoring my grasping at straws.
I follow Cuban on Twitter and he retweets people constantly who are saving substantial amounts of money. In their own words the savings are huge. Are you claiming these people are lying or fake?
Just out of curiosity, I looked at some of the costs for the most prescribed meds. All seemed to within the same price range. Personally, I liked the GoodRx UI better.
Not that what Cuban is doing is "bad" but I don't know that it needs to be characterized as some radical new alternative. That seems more like marketing hype to me but it does a good job of raising awareness.
2. Scroll down on GoodRx. $787 is the price from CVS; other pharmacies like Rite Aid offer it at ~$114.
Obviously still a jump! Just not a $700 one.
Because it's probably paid advertising. Almost every article is paid advertising.
Why do you have this reaction to just this particular business? Do you have it for other businesses? Like a low-cost supermarket opens up and you're upset that they're not really growing their own food? At this point, I would applaud any competition in the US health care space, especially if it adds transparency.
Cuban found there is margin that can be squeezed in the pharma market due to being a high margin product with inefficient distribution. He moved on a revenue opportunity, plain and simple.
The end result is the anti-fans come off delusional and out of touch with reality.
Regarding Musk's loop and Boring company, I would also consider those a mild good. Hyped to high hell, but I don't see how that ever becomes bad.
What is awful about cheaper all electric tunneling rigs? If if meets some of the claims, then cool, if it doesn't, then it is neutral.
I am honestly curious why you think it is pretty awful?
One major issue with their rigs would be the future impact of their tiny tunneling. They tunnel such small holes that make the actual end products weak. Their Vegas tunnel are so small. God forbid there’s an emergency while there’s a lot of traffic. Good chance lives will be lost.
Vs the amount of results for their main product they’ve done and sold that isn’t a blow torch: the Vegas loop. That’s what I was talking about. It seems to be an awful idea that is widely seen as a disappointment now. Their LA plan was by far much stupider. They were trying to do a tiny fraction of the traffic that an electric underground metro could do while being much less energy efficient since trains are more efficient than a lot of cars.
There’s a boatload of issues that make the tunnel awful and nothing more than a way to push Teslas more. All I can find are negative takes of the Vegas loop. I can’t add anything others aren’t saying.
It’s hard for me to see how the entire thing isn’t a scam to push Tesla. It’s mine boggling that this isn’t getting the same treatment as Morbius the film (intense loud continuous mockery). Then I remember the insane amount of fans and the push to keep everything Elon positive.
All of that said, I don't think that makes the idea BS. The company is able to save many people money on prescriptions, which is a good thing. That Cuban or his company makes money on the way shouldn't bother us in the least (unless/until we ever get single payer).
[1] Their website says they will start manufacturing drugs this year
[1] https://www.markcubancostplusdrugcompany.com/
If he saves the consumer a lot of money, does it really matter if he takes 15% of the txn? Secondly, dont people/companies deserve to be paid for value they add?
My US-specific experience is that customers are squeezed for a pound of flesh. These often come at the worst time, when you are sick, possibly really really sick. For example, you're deathly ill, on line at CSV, and you're arguing about a $200 mystery co-pay for a prescription you cant wait days for. Luckily for me as a SWE, I can afford $200 mystery charges. For some it could mean death.
Any way to create transparency of pricing is really important, and could lead to live and death moments. I dont think we should dismiss these lightly.
I can't find any magic numbers here that explains how the proposal here to replace the "middleman" lowers prices ... by just being another middleman...
But if he’s able to have a profitable drug company that doesn’t produce drugs that lowers costs for consumers.. Welp that kinda shows that the system is in need of some change.
Good on this company for helping that though. Hopefully the clever people in the industry take notice and further improve things.
Color me shocked if it ends up harming independent pharmacists, though... and I say that as someone who thinks universal healthcare is the way to go in the US. Wonder how long before he decides to sell this company to Walmart.
This will not save more money than GoodRx.
Should I care? They're still middlemen at the end of the day.
It's a good thing that people will receive drugs at low prices, but most drug companies have programs to deliver them for low prices anyway. When those local pharmacies die, then large companies will step in and jack up the costs anyway. And if you don't believe that Cuban would sell that company, then you haven't paid attention to his history. The man is many things, but altruistic isn't one of them.
The actual business (so far) is pretty straight-forward: 1. Call an API to TruePill pharmacy 2. They fill it under the Costplus label and mail it. 3. Cost of drug is acquisition + a small markup that Costplus and Truepill share 4. Display the Truepill API fields in a NEXT.js website
I totally respect Truepill operational chops too. Pharmacy is a very tough business.
I am waiting for someone to figure out how to break the PBMs pricing-power (monoply-like) control over that business. That would be the true breakthrough. Maybe it would be costplus in a pivot. Or a regulatory change.
Also - I deal with CivicaRX in a daily basis. It is a valiant attempt, but they have major shortcomings.
FYI: If someone wants an API that really tells how much drug costs. (trust, but verify!)
https://data.medicaid.gov/dataset/dfa2ab14-06c2-457a-9e36-5c...
1. Your insurance can and will block certain pharmacies if they got big enough (see PillPack before the Amazon acquisition). They have their own pharmacies and route the most profitable scripts there.
2. You would run into market size limitation if you decide to never accept insurance
3. Getting someone to switch their pharmacy requires major effort on their part - as well as the cooperation of all their doctors. It's almost like switching IT vendors!!
Is my local CVS an "expensive pharmacy"? No clue, but before Cuban's website I didn't even consider that these type of businesses could help lower my drug costs even below what I pay WITH insurance.
There's also a huge disconnect between people who occasionally need prescriptions, and those that rely on prescription medication daily. If you get one script a year it probably doesn't matter, but if your disease requires a drug that costs $5K/month, you get very informed, very fast.
Except I work in industry, both specialty and retail pharmacies.
For any chronic disease (the ones this program benefits most), most doctors will get you setup with the cheapest option for your insurance / PBM. As cost of treatment is the #4 indicator whether people will fall off treatment in the United States[1]. Additionally, in a retrospective study, cost was cited as the main reason for non-adherence in 17% of cases, making it the #3 leading cause[2]. This number is as high as 55% depending on age / demographic... Doctors working in chronic diseases know this and have to deal with it like any other adherence issue.
For one off treatments, people usually just go to their grocery store or local pharmacy.
Are there patients who are over paying? Absolutely. Is this a cash grab by a multi-billionaire because its not actually addressing the issues resulting in expensive drugs? Absolutely.
[1] adherence to refills and medications scale [2]https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3934668/
> Are there patients who are over paying? Absolutely
But then, you dismiss all of that by implying this is a useless exercise because patients who need low cost meds are getting them.
Which one is it?
The insurance companies are one of the main problems. It sounds like this doesn't solve that.
https://www.nhs.uk/nhs-services/prescriptions-and-pharmacies...
The US has one of the highest per-capita spends on healthcare in the world[1] for demonstrably poorer health outcomes[2].
[1] https://en.wikipedia.org/wiki/List_of_countries_by_total_hea... and elsewhere
[2] eg the CIA factbook all-cause mortality table shows Bangladesh as having about half the mortality rate of the US. https://web.archive.org/web/20201010211308/https://www.cia.g...
Good to know.
That article is a bit short on details. Some other recent articles I thought were more helpful included https://www.healio.com/news/rheumatology/20220428/mark-cuban... and https://www.drugtopics.com/view/the-good-the-bad-and-the-mis... . The second article is written more from the perspective of independent pharmacies.
The first article includes this snippet: "If there is reason for optimism, though, it lies with the medical background of Oshmyansky, the company’s co-founder and CEO, according to Gewanter.
'The radiologist Cuban is working with knows the business,' Gewanter said. 'Between the two of them, it is not difficult to imagine that they will figure out where the gaps are and how to exploit them. We can only hope that when they do, our patients will be the beneficiaries.' "
I think YC made a fantastic choice including Alex's company in YC, and it's been a pleasure seeing what Alex has done and is doing. I'll stop there for now.
Anyone who claims the solutions to the U.S. healthcare problems are simple doesn't understand the U.S. healthcare system.
The problem with the "simple" solutions is they often assume we start from a blank slate. Acknowledging we're not starting from a clean slate where do you propose we simplify first? And before you reply can you think about 1) how will it be done, including the political aspect and 2) what is the potential unintended blowback from that change?
I am all for picking whatever the lowest price is. That is the whole goal.
This is very interesting but not because Cuban's business model is unique. It suggests that this group, who are probably a bit more net savvy on average, were not aware of other similar businesses like GoodRX.
This implies that there is a highly in demand product (cheap medication) but the problem is awareness, so it's a marketing challenge. Cuban is very well positioned to solve this problem by using his personal brand and tools like these PR articles.
This is a good thing! He has the brand, marketing chops and resources to drive it forward. It will increase the size of the market, meaning more people have access to life changing affordable medication. This may spawn more clones of the business model, further increasing the market size, rinse repeat. If this market gets big enough maybe it will apply pressure for change upstream? That would be a great thing.
Here on HN we are heavily weighted in our thinking towards the value of product in business (which is normally undervalued) and that is great, but examples like this reveal a real blind spot. Sometimes the value of something like marketing is forgotten or even worse dismissed. But they're extremely powerful tools when used correctly. Apply good marketing to a good product and you have Apple.
There are folks in this thread alone finding CostPlus prescriptions for significantly less than GoodRx.
Your tone is dismissive - how confident are you that Cuban’s pricing is not actually cheaper, and is just glitz?