Prescription drug prices in the United States have been a major concern for years. Many people struggle to afford the medications they need, even with insurance. To address this issue, entrepreneur Mark Cuban launched the Cost Plus Drugs Company, an online pharmacy that takes a radically different approach to drug pricing. The goal is simple: to make medications more affordable and more transparent.
Why Was Cost Plus Drugs Created?
Mark Cuban’s pharmacy was born out of frustration with the traditional pharmaceutical system. In the U.S., prescription drug prices are often inflated by multiple layers of middlemen. Pharmacy benefit managers (PBMs), wholesalers, and insurers all add their own markups, making it difficult to know what a drug truly costs.
Cuban’s program strips away much of this complexity. Instead of dealing with rebates, secret negotiations, and varying copays, Cost Plus Drugs focuses on transparent, predictable pricing.
How the Pricing Model Works
The key feature of Cost Plus Drugs is its cost-plus model. Every medication is priced according to a simple formula:
- The manufacturer’s cost of the drug
- Plus a 15% markup
- Plus a $5 pharmacy fee
- Plus the cost of shipping
That’s it. No hidden fees, no middlemen. This often results in prices that are dramatically lower than what patients would pay at a retail pharmacy, even if they’re using insurance.
Who Can Use Cost Plus Drugs?
The program is open to anyone in the United States with a prescription. You don’t need to have insurance to use it. In fact, many people who are uninsured or underinsured find the biggest savings through the program.
That said, even people with insurance can sometimes save money. If your insurance copay is higher than the Cost Plus Drugs price, it may make more sense to purchase through the program instead of using your insurance.
Limitations to Be Aware Of
While the program is innovative, it’s not a perfect solution for everyone. Here are a few things to consider:
- Generic focus: Cost Plus Drugs mainly sells generic medications. While they’re working to expand their list, you may not find every drug you need, especially brand-name or specialty medications.
- No insurance billing: You can’t use your insurance directly with Cost Plus Drugs. If you want the cost to apply to your deductible, you’ll need to check with your insurer about possible reimbursement.
- Shipping times: Since it’s a mail-order pharmacy, it may take several days for medications to arrive. It’s important to plan ahead, especially for maintenance drugs.
- Limited formulary: While the list of available medications is growing, it doesn’t yet cover every prescription drug on the market.
How It Works With Medicare
For Medicare beneficiaries, Cost Plus Drugs can sometimes offer lower prices than Part D copays. However, because purchases aren’t billed to Medicare, they won’t count toward your deductible or out-of-pocket maximums in your Part D plan.
This means Cost Plus Drugs may be a good option if:
- You’re in the deductible phase of your Part D plan and paying full price.
- Your copay for a drug is higher than the Cost Plus price.
- You take a generic medication that’s not favorably priced on your plan’s formulary.
Still, it’s wise to compare your options. Sometimes using your Part D plan is better for long-term cost tracking, especially if you anticipate reaching the coverage gap or catastrophic coverage.
How to Get Started
Using Cost Plus Drugs is straightforward:
- Visit their website and search for your medication.
- Compare the listed price with what you currently pay.
- If you decide to use Cost Plus Drugs, your doctor can send the prescription directly to their pharmacy.
- Once filled, your medication will be shipped to your home.
Discuss Drug Costs with Carolina Senior Benefits
If you’re struggling with high drug costs, it’s worth checking the Cost Plus Drugs website to see if your medications are available. Even if you don’t use it for every prescription, it may provide significant savings on the medications that matter most.
Also, don’t forget that there is still time to change your Medicare Part D plan for next year! The Annual Election Period (Oct 15 – Dec 7), allows you to change to a new Part D plan for the upcoming year. Be sure to use this time to review your plan and uncover any potential savings!
