Mark Cuban needs little introduction. The entrepreneur and investor behind Cost Plus Drugs has become one of the loudest voices in American healthcare, challenging the way employers buy benefits, the way PBMs operate, and the way pricing stays hidden across the system. In 2022, he launched Cost Plus Drugs, an online pharmacy that sells medications at their actual manufacturing cost plus a flat markup and a small pharmacy fee. Since then, he has expanded into direct contracting with providers, employer health plans, and Direct Primary Care. In conversation with Mehul Agarwal, CEO of HealthCompiler, Cuban shared his views on what self-funded employers should be doing differently, why he believes the conglomerate model is designed to extract value rather than deliver it, and why Direct Primary Care is a worthwhile investment for any company willing to think independently about benefits.
The Interview
You have challenged traditional pharmacy pricing through Cost Plus Drugs. What lessons from that experience should employers apply to the rest of their healthcare spending?
Avoid any big conglomerate. Do not do business with them. They exist just to rip you off
If you were designing a healthcare benefits strategy today for a self-funded employer with 500 to 10,000 employees, what would you change first?
I would hire someone from an independent TPA to work full time for me to do nothing but deal with the economics of our benefits. Completely outside of HR
Direct Primary Care gives physicians more time with patients and reduces dependence on fee-for-service billing. What role do you believe DPC should play in employer-sponsored healthcare?
I think it's money well spent to have employees all on DPC. I do with my companies
Employers receive enormous amounts of claims, pharmacy, eligibility, and care data, yet many still cannot explain what is driving their healthcare costs. What information should every employer demand from its vendors?
All of their claims and to run them through an auditor. They will find a ton of places you overpaid
What are the biggest conflicts of interest employers should look for when selecting brokers, TPAs, PBMs, health plans, and navigation vendors?
Avoid the conglomerates. Don't use brokers or consulting firms to choose any benefits. Hire an independent individual who has worked at a TPA to help
Cuban's Public Stance on Healthcare Transparency
Cuban has been vocal about healthcare pricing long before this interview. His formula is simple: trust equals transparency divided by self-interest. When self-interest is high and transparency is low, the system fails the people paying into it.
He has taken that argument to the U.S. Senate, where he testified in October 2025, calling for full transparency in PBM contracts. On X and in public appearances, he has repeatedly told self-funded employers that they have more power to change healthcare than any politician, urging them to demand transparency, audit every claim, and pay cash prices than going through the PBM channel. He has also warned that many employers are unknowingly collecting drug rebate money funded by their sickest workers, a practice that can raise fiduciary concerns under ERISA.
He has backed the talk with action. Cost Plus Drugs proved that a pharmacy could operate on a transparent, cost-plus model. Cost Plus Wellness, launched in 2026, extended that logic to medical care, connecting self-funded employers directly with providers through publicly posted contracts with no intermediaries, no spread pricing, no balance billing, and no hidden fees. Cuban has also enrolled employees at his own companies in Direct Primary Care memberships, something he confirmed in this interview.
His message to employers is consistent: avoid the conglomerates, hire someone independent who understands the economics, audit every claim, and ask harder questions to the people managing your benefits.