On The Hill


Pittsburgh-Born Billionaire Mark Cuban Gets It Right on Lower Cost Prescriptions

This is a personal story, and once again illustrates advocacy does work and shows how a Manufacturer & Business Association (MBA)-supported prescription drug bill has come full circle. Kudos are due to Mark Cuban.

If a patient went to the pharmacy to drop off a prescription before July 2020, a long-standing “gag clause” imposed on pharmacists prohibited them from informing customers of lower-cost alternatives at the pharmacy counter. Please thank Pennsylvania Representative Valerie Gaydos for her legislation, signed into law as Act 67 of 2020. It increases transparency and consumer choice in the prescription drug marketplace. Gaydos is also the prime sponsor for MBA’s Association Health Plan legislation, House Bill 555.

My Story

I take a maintenance prescription drug that has been a Tier 2 drug in the UPMC formulary for several years. Every year, I request a tier exception to drop the drug to Tier 1 where drugs are low or no-cost. The exception has always been granted. This year was different. I called in October as usual requesting a tier exception from 2 to 1. I hadn’t combed the formulary and was unaware that the drug was moved to Tier 3. They granted my tier change request, but they only dropped the prescription to Tier 2 instead of Tier 1.

I filed a grievance as suggested. There were several calls and helpful people along the way. The reasoning I heard was that my prescription was now a Tier 3 (according to Federal rules — CMS or other — a drug can only drop one tier). What I needed was a drop from Tier 3 to Tier 1 to receive the lowest price.

My final conversation was with a UPMC pharmacist. She was very helpful, explained everything and, ultimately, my prescription was dropped from Tier 3 to Tier 1. The pharmacist, no longer subject to the gag rule, thanks to Act 67, also told me about Mark Cuban’s Cost Plus Drug Company and said shopping could always be done there to look for better drug prices. Employers, this is a site you may want to share with your employees.

I visited and found if I hadn’t been granted the drop to Tier 1, I could have purchased the same drug for a cost mid-way between the Tier 1 and the Tier 2 price. That works wonderfully when knowing a maintenance prescription never goes away and adds significant costs over a period of time.

Big Thanks

Kudos to Gaydos’ legislation supported by the MBA, which allowed the pharmacist to educate patients about cheaper drugs. Kudos to the pharmacist for taking time to do so. Kudos to UPMC’s concierge service. Kudos are due to Pittsburgh-born billionaire Mark Cuban.

According to Cuban’s website: “The Mark Cuban Cost Plus Drug Company is dedicated to producing low-cost versions of high-cost generic drugs. We pledge to provide radical transparency in how we price our drugs.

We will let everyone know what it costs to manufacture, distribute and market our drugs to pharmacies. We add a flat 15% margin to get our wholesale prices. This makes sure we remain viable and profitable. There are no hidden costs, no middlemen, no rebates only available to insurance companies. Everybody gets the same low price for every drug we make.

Our goal is that everyone should be able to afford their medicine. Everyone should know what it cost to make their medicine.

Everyone should feel the price they paid for their medicine was fair.”

According to Forbes, Cuban is an American billionaire entrepreneur, television personality and media proprietor whose net worth is an estimated $4.8 billion.

Yes, sports fans, he is a majority owner of the NBA’S Dallas Mavericks.

Thank you, Mark Cuban, for using your entrepreneurial skills in the private market to accomplish what Big Pharma and Grid- Locked government cannot do.

If you are interested in learning more, contact me at