By Gina Shaw

Generic imatinib (Gleevec, Novartis) for $17.10 per month, compared with $2,502.80 at retail? Generic memantine (Namenda XR, Allergan) for $12.90 per month, compared with $359.42 at retail? Generic esomeprazole (Nexium, Pfizer) for just $6, compared with $216.66?

These are just a few of the 27 drugs that will be discounted by $100 or more per prescription—sometimes a lot more—from billionaire Mark Cuban’s generic drug company, Mark Cuban Cost Plus Drug Co. (MCCPDC), which officially launched Jan. 19, 2022.

Mr. Cuban, the owner of the NBA’s Dallas Mavericks and star of ABC’s “Shark Tank,” is the latest entrant into a growing field of competitors seeking to disrupt the prescription drug ecosystem. Like earlier players such as GoodRx and Amazon Pharmacy, MCCPDC aims to reduce the seemingly endless increases in out-of-pocket costs that patients pay for prescription drugs.

“I think this is a huge and welcome pushback against the preposterous pricing that ends up at the consumer level,” said pharmacy consultant Bonnie Kirschenbaum, BSc, MS, a member of the Specialty Pharmacy Continuum editorial advisory board. “There needs to be shock waves like these to show that we can do it differently. If they become a big enough phenomenon, maybe they will force other change in the traditional way of doing things.”

Different Approaches

GoodRx, which was founded in 2011, doesn’t provide pharmacy services. Instead, it acts as a comparison-shopping service, collecting the best prices, coupons and discounts to help consumers find the lowest-cost pharmacy for their prescriptions—both brand-name and generic drugs. It also has a prescription discount card and coupons of its own.

On the other hand, Amazon Pharmacy, launched in 2020, and MCCPDC actually provide mail-order pharmacy dispensing services: Amazon Pharmacy through its own pharmacy subsidiary and MCCPDC via a partnership with Truepill, which offers pharmacy fulfillment through pharmacies accredited by URAC.

Amazon Pharmacy has pharmacists on call 24/7 at its customer care number and offers either out-of-pocket payment options or insurance payments. Separately, Amazon Prime members can use the Amazon Prime Rx prescription drug benefit, which offers 40% to 80% discounts off the cash price of generic and brand-name drugs at thousands of pharmacies nationwide, including CVS, Rite Aid, Walgreens and Walmart.

MCCPDC is a cash-only model that directs customers with questions to call Truepill directly through a number on their prescription bottle. “Because the company refuses to pay spread prices to third-party PBMs [pharmacy benefit managers] in order to be allowed to process insurance claims, the online pharmacy will be a cash pay venture,” the company’s launch statement said.

MCCPDC also touts transparency in pricing. “Every product we sell is priced exactly the same way: our cost plus 15%, plus the pharmacy fee, if any,” a letter from Mr. Cuban on the company’s website said. There’s also a $5 shipping cost per prescription. 

Mr. Cuban’s savings claims are legitimate, although they may not be quite as large as advertised when compared with what other industry disruptors are offering, said Ann Johnson, the president of industry consulting firm Pharmacy Healthcare Solutions (PHSL).

“They had touted 27 different drugs where you could save more than $100 per prescription. For 25 of those drugs, I could find pricing on GoodRx, and 22 of those 25 did have a lower cost at MCCPDC, although on average it was about $27.37 less,” Ms. Johnson said. “So, I’m not sure it’s quite the delta that is being claimed, but yes, there are some additional savings there for patients.”

As of early 2022, Amazon had a much larger array of available medications than MCCPDC’s 110 or so, although it does not dispense specialty drugs, Schedule II controlled substances, or Risk Evaluation and Mitigation Strategy medications or suspensions.

Because MCCPDC ships only through the U.S. Postal Service and other ground carriers—for now, at least—temperature-controlled medications are still off Mr. Cuban’s list. That includes one drug whose high out-of-pocket costs for many consumers have made recent headlines: insulin. A search on Feb. 4, 2022, found Amazon Pharmacy offering a vial of insulin lispro (Humalog, Lilly) for $43.40 and insulin aspart (Novolog, Novo Nordisk) for $148.10. On the same day, GoodRx had coupons that would bring the cost of insulin lispro as low as $43.43 and insulin aspart as low as $58.83, both at Walgreens. (A provision in the House of Representatives–passed Build Back Better Act would cap out-of-pocket costs for insulin at $35 per month.)

‘Wow, Finally!’

Many patient advocates welcomed the move. “My initial reaction was, ‘Wow, finally!’” said Gunnar Esiason, the son of sportscaster Boomer Esiason, who lives with cystic fibrosis (CF) and serves on the board of directors at the Boomer Esiason Foundation and No Patient Left Behind, a nonprofit dedicated to making drugs affordable. “The cost of taking care of future cohorts of patients is essential to consider, especially in the era of breakthrough medications. Here we see someone finally trying to pass on the value of generic drugs to patients.”

Like Ms. Kirschenbaum, Mr. Esiason said he hoped that MCCPDC would create competitive disruption to drive down out-of-pocket costs to patients, particularly those who need any kind of breakthrough medication. “Everyone has their wish list of what they would like to see available from them,” Mr. Esiason told Specialty Pharmacy Continuum. “People with cystic fibrosis do rely on innovator drugs like Kalydeco [ivacaftor, Vertex], but most of the drugs I actually take are generic. The drug I actually have the hardest time getting hold of is a generic vitamin K drug, for which the out-of-pocket cost is normally well over $50.”

Impact on Other Pharmacies

What do disruptive forces like Amazon and MCCPDC mean for other leading players in the pharmacy space? Specialty Pharmacy Continuum reached out to several major pharmacies and PBMs, including CVS, Express Scripts and Optum, and received no response or a decline to comment. Walgreens corporate spokeswoman Rebekah Pajak said the company does not comment on competitors’ activities, but stressed Walgreens’ offerings and efforts to help patients save money on medications.

“To assist patients who don’t have insurance, the Walgreens Prescription Savings Club is a discount prescription drug program offering savings of up to 80% off cash retail prices of prescriptions purchased at participating Walgreens. Savings apply to more than 8,000 brand and generic medications, including many value-priced generics available at $5, $10 and $15 price points,” Ms. Pajak said. “From September to November of 2021, Walgreens Prescription Savings Club members have saved over $125 million compared to the cash retail price on prescriptions. In addition to the Prescription Savings Club, Walgreens also accepts a number of other discount program cards.

“When choosing a pharmacy, we encourage patients to select one that offers the best value based on pricing and also the services available—such as participation in government plans, 24/7 convenience and services that can accommodate immediate prescription drug needs,” she added. “It’s also important for patients to use a single pharmacy so that pharmacists can monitor their medications and avoid potential drug interactions.”

That issue is definitely a concern, noted PHSL’s Ms. Johnson. “From a safety perspective, MCCPDC is only filling prescriptions for about 100 medications, and they won’t have full patient profile information,” she said. “This trend in general encourages pharmacy shopping, which means that no one pharmacy is going to have a complete look into the patient’s profile and all the medications they’re taking, which runs the risk of missing drug–drug interactions and other patient safety concerns.”

Pharmacists’ Role Diminished?

Online discount pharmacies also run the risk for reducing pharmacists’ role in patient care, added Tim Kosty, PHSL co-founder. “It’s unknown in my mind how the consumer will decide. Do they care about the personal services such as medication management or the ability to get a vaccine or a test that a pharmacist provides, or do they care about the lowest price? Every consumer has to balance that cost-versus-service factor.”

Mr. Esiason said he shared Mr. Kosty’s concern, particularly for smaller independent community pharmacies. “When I lived in New York as a child and young adult, we used a mom-and-pop pharmacy who were so remarkably helpful,” he said. “They knew the people with CF who lived in town, and which drugs to always have on hand in case we needed them for a pulmonary exacerbation. It’s very different when you’re dealing with a remote pharmacy. I’m hopeful that this competition is going to push downstream into the PBMs, so down the road those mom-and-pop pharmacies will be able to thrive.”

He also expressed hope that Mr. Cuban’s move would spur policymakers to take action. “Generics are so valuable because they bring the cost of prescriptions down, but if patients still face huge out-of-pocket costs for those generics, something is wrong,” he said. “Policymakers urgently need to address the out-of-pocket costs associated with all drugs, branded as well as generics. If you cut the cost of those top CF drugs like [ivacaftor] by 75%, they’re still unaffordable for virtually everyone. That’s unsustainable and has to be addressed.”

Ms. Johnson, Ms. Kirschenbaum and Mr. Kosty reported no relevant financial disclosures. Mr. Esiason disclosed the following: “Boomer Esiason Foundation accepts donations from across the health ecosystem: specialty pharmacies, health insurers, hospital systems, drug companies and medical device companies. We are thoughtful in taking in funds from all players so that our patient advocacy doesn’t lean towards a perceived favorite.”