Consumers and employers are struggling to keep pace with the rising cost of prescription medications, and large pharmacy benefit managers are coming under increased scrutiny as a source of the high prices
A new analysis shows the independent pharmacy Cost Plus Drugs charges buyers on average 67% less for medications than what typical corporate-owned pharmacy managers charge.
The analysis by 3 Axis Advisors, a paid consultant for Cost Plus, examined prescription drug costs paid by employers, which provide insurance health benefits for most working-age Americans. It suggests that Cost Plus saves employers about $47.50 for every prescription filled compared to pharmacy benefit managers, or PBMs.
While the report doesn’t directly measure how much consumers
pay at the pharmacy counter, employer costs are shared by consumers who typically pay a portion of the bill through copayments and deductibles required by their insurance plan.
The analysis comes as Congress and employers increasingly are scrutinizing pharmacy benefit managers and overall spending on prescription medications. PBMs negotiate drug prices on behalf of employers and consumers. Most employers use one of three large PBM companies – CVS Caremark, Express Scripts and Optum RX.
A recent survey found the share of employers contracting with the three largest PBMs dropped from 63% in 2025 to 54% in 2026. And among employers remaining with those three large PBMs, more than half are considering changing or dropping their benefit manager over the next one to three years, according to the survey by the National Alliance of Healthcare Purchaser Coalitions.
Employers are considering changes because they are fed up paying runaway costs for hospitals, doctors and pharmacies, experts say.
Employers are “leaving the three big PBMs because they don’t know what they’re paying for,” said Jenny Goins, interim president and CEO of the National Alliance of Healthcare Purchaser Coalitions. “The contracts are written in such a way that you need three or four lawyers to tell you what it says.”
A recent Government Accountability Office report found that health conglomerates that own PBMs and pharmacies usually give their own pharmacies better prices on prescription medications. The study shows that patients and taxpayers might not be getting a fair deal, according to U.S. Rep. Lloyd Doggett, a Texas Democrat.
“There is a real danger that consumers and taxpayers are being ripped off by giant health conglomerates,” Doggett said.
Employers want transparent drug pricing
Goins said more employers are gravitating toward smaller PBMs that offer more transparent pricing models.
Other experts agree that employers are becoming more choosy when shopping for prescription drugs on behalf of their workers. Some employers choose a combination of multiple vendors, including Cost Plus Drugs, to manage prescription drug benefits.
"We are definitely seeing employers be more aggressive in how they try to structure their pharmacy benefits," said James Gelfand, President & CEO of The ERISA Industry Committee, which represents companies that provide employee benefits. "All of this is to try and control costs and keep drugs affordable for workers and families."
Cost Plus Drugs, which was launched by entrepreneur Mark Cuban, touts that it sells prescription drugs at the same price it pays a drug manufacturer, plus a 15% markup to cover operational costs. There are no common PBM tactics such as rebates or spread pricing − charging an employer or other insurer more for a drug than what it pays a corporate-owned pharmacy as a reimbursement for dispensing the medication.
The 3 Axis report sampled employers that paid 2024 prescription drug insurance claims totaling more than $433 million on behalf of workers and their families. The report said Cost Plus Drugs, which mainly sells lower-cost generic drugs and biosimilar medications, would have been able to fill more than 70% of those prescriptions.
Still, the report notes, Cost Plus doesn't typically carry many of the pricier specialty drugs that can drive costs higher for employers. Of the medications it carries, Cost Plus prices would deliver an average savings of 67% compared to PBMs, the report said.
But the report points out potential savings that some employers might pursue by choosing multiple vendors. An employer might get generic drugs from Cost Plus, for instance, while relying on a PBM for specialty drugs, according to Gelfand.
3 Axis Advisors noted that its report doesn't account for rebates that PBMs might share with employers on brand-name drugs. PBMs often demand rebates from drug manufacturers for brand-name medications, and some or all of those savings could be shared with employers, the report said.
Cuban said most of the drugs in the 3 Axis report are generics, which offer no rebates.
"We charge the same price to everyone," Cuban told USA TODAY. "Few others, if any, do this. Because the big PBMs try to maximize profits, they will price as high as a contract will let them."
A spokesman for the Pharmaceutical Care Management Association, which represents PBMs, said the 3 Axis analysis falls short.
"Mark Cuban's company offers only a fraction of the drugs that patients need from a real drug benefit, and this report, like most of Mark Cuban's claims, relies on cherry-picked drugs that categorically misrepresent the value PBMs provide 289 million Americans," said Brendan Buck, PCMA's chief communications officer.
However, Goins said many employers have grown frustrated with the lack of price transparency with the large PBMs, which is one reason they are switching to smaller entities with more transparent pricing.
Many employers don't get full access to claims data, so they don't know details on the medical and prescription drug bills they're paying, said Antonio Ciaccia, president of 3 Axis Advisors and the report's co-author.
"You're asking them (employers) to navigate a marketplace with a blindfold on," Ciaccia said.
A law passed by Congress earlier this year would require PBMs to disclose more details to employers that fund their own insurance plans. The Department of Labor drafted a rule that would require PBMs to disclose more information about payments, rebates and pricing.
Another study suggest consumers with employer insurance might find savings on their own if they shop directly from Cost Plus.
The study, published in the Annals of Internal Medicine, said consumers who had to spend $15 or more on copays could save money nearly 80% of the time when they shop from Cost Plus or other direct-to-consumer pharmacies. The savings could be greater when consumers have to spend $100 or more for higher-priced generics used to treat cancer, digestive issues, psychiatric and heart conditions, the study said.
The study only examined people with employer-sponsored health insurance, not those on a government health insurance program such as Medicare of Medicaid. The study also didn't compare potential drug savings of other consumer websites such GoodRx.
Cuban told USA TODAY he expects more companies to scrutinize prescription and health care spending because costs are rising too quickly.
"Companies can't afford the cost of health care any longer," Cuban said. "Every penny they save goes right to the bottom line."
This article originally appeared on USA TODAY: How Mark Cuban's drug prices compare to corporate-owned pharmacies
