After Shark Tank, Mark Cuban Just Wants to Break Shit—Especially the Prescription Drug Industry

Mark Cuban was confident he wouldn’t be recognized in Boston Common. This was early June, and it happened to be the day of the Boston Dyke March, billed as an “anti-capitalist intersectional gender liberation” event. Earlier that day, outside of his hotel, people had bum-rushed the billionaire, angling for an autograph or selfie. Basketball fans on the street lit up at the sight of him—the minority owner of the Dallas Mavericks. But as we strolled the 50-acre stretch of green, considered the oldest public park in the US, Cuban the capitalist assured me that this anti-capitalist crowd couldn’t be less interested in him.

“Mark Cubannnnn!” a young woman screeched just then. She hurried over. Her friends joined. They were infectiously joyful, wearing strips of rainbow fabric fashioned into skirts, and they wanted a selfie. Cuban obliged, beaming like a dad.

Cuban, now 66, is at a turning point. Late last year he announced that the upcoming season of ABC’s Shark Tank, the reality show that catapulted him to fame, would be his last. He also sold off his controlling stake in the Mavs. Was the tech entrepreneur and investor … slowing down?

The suggestion is offensive to him. He simply has a new obsession. In 2018, Cuban received an email that, to him, smelled like blood. A 33-year-old radiologist named Alex Oshmyansky was cold-pitching a pharmaceutical startup. He wanted to sell generic drugs for about as much as they cost to make or buy. Cuban was intrigued. He invested $250,000.

Within two years Cuban had invested so much that he owned the company. In January 2022 they began selling products as Mark Cuban Cost Plus Drugs. The name references, well, Mark Cuban, but also simple algebra: the base price of the drug, plus a 15 percent markup, plus a $5 pharmacy service fee, plus $5 in shipping. The company ships around 2,500 drugs, including ones for epilepsy, diabetes, and birth control, to consumers and pharmacies across the US.

What excited Cuban was the way Oshmyansky wanted to subvert the middlemen in America’s famously contorted health system. Pharmacy benefit managers, or PBMs, sit between drugmakers, insurers, patients, and pharmacies. They’re largely responsible for setting all kinds of details: what drugs a patient’s insurance will cover, how much they cost, what slice a pharmacy gets. They claim to be money-saving heroes. But as a recent New York Times investigation found, PBMs can charge drugmakers and employers extra fees, effectively jack up prices for patients, and contribute to driving independent drug stores out of business.

When I meet Cuban for breakfast at a posh Boston hotel, the kind of place with soft jazz and gas fireplaces going even on the muggiest days, he’s on a tear about PBMs. Their trade groups demonize drugmakers as badly as “the Republicans demonized Hillary Clinton,” he claims. Cuban says he’s not driven by any personal experience with health care. He simply saw a chance to rip into a dysfunctional industry.

Cuban is also outspoken about tech platforms and politics. He’s an active Xer and doesn’t hesitate to take on Elon Musk. He has alleged that Musk manipulates the platform’s algorithm, and he took it in stride when Musk referred to him as a poop emoji. At the time of our breakfast, President Joe Biden was still on the ticket, and Cuban had stern messaging for his campaign team: Loosen up your stance on taxing crypto or lose the election. When we caught up a second time, in August, Cuban said he’s impressed by the way Democratic presidential nominee Kamala Harris is punching back at the Trump campaign’s aggressive rhetoric, and the “Bring Your Dad to Work Day” energy that Tim Walz exudes. And he likes that the duo might draw in moderate voters and tamp down some of the chaos the US has endured in the past eight years.

Although, Cuban himself seems to thrive in chaos.

Lauren Goode: Things have been changing for you lately. You’re leaving Shark Tank. You sold your majority stake in the Dallas Mavericks. Are you going through a midlife crisis?

Mark Cuban: No, no, no. The exact opposite. It’s more platforming for the next step. I don’t look at myself and think, “I’m a man of a certain age, I’ve got to change what I’m doing.” No. It’s more like, I like to disrupt things. I like to play the game. I like to compete in business, and Cost Plus Drugs could be the biggest thing I’ve ever done.

Why?

If I said to you, Lauren, you could change health care in this country, would you do it?

I mean, yes, given recent experience with doctor’s appointments. It’s all opaque. I have no idea what kind of bill I’m going to get.

Nobody has any idea. Going back to 2017, the Republicans were talking about getting rid of the Affordable Care Act. I talked to various people who had no idea what they were going to do for health care. So I said, “OK, let me dig into it.” I started working on various plans. I worked with the Rand Corporation to come up with some ideas.

Then, in 2018, I got a cold email from Alex. He said he wanted to do a pharmacy for drugs that are generic and in short supply, because there are various drugs, like ones for pediatric cancers, that people can’t get, and it’s insane and someone needs to make them.

I’m like, “That’s a great idea, but you’re thinking too small.” This was around the time that Pharma Bro was going to jail for all his shit. [Martin Shkreli, who was convicted of securities fraud, had a company that bought the marketing rights for an antiparasitic drug and raised the price of a pill from $13.50 to $750.] I said to Alex, “Why can’t we also buy out a year’s supply?” He said it would cost us about $250,000. I’m like, “Are you kidding me? Only $250,000? Great.” The problem is, you can’t buy it, because somebody already locked it up.

In terms of intellectual property?

No. They bought the entire year’s supply. [The waiter comes and offers coffee.] Can I get an oatmeal with just raisins? Nothing else.

That’s very specific, just raisins.

Yeah. I have no willpower, and if it’s in front of me, it’s gone.

Speaking of gone … so someone locked up the drug.

Right, they went to the manufacturer and got a de facto exclusive. Because if there’s only 100 or so people that use it in a given year, they can jack up the price. I thought it was fucked up that could even happen. I started digging further.

The biggest problem isn’t the care itself, and it’s not the pharma side. The pharma manufacturers are perceived as bad guys because they’re the ones with the patents, but they’re not the bad guys, generally.

What do you mean by that?

Because your insurance company, whoever it may be, uses a PBM, a pharmacy benefit manager. The PBM has negotiated with a pharmacy what the reimbursement rate is. Except they basically said, “Here’s what we’re going to reimburse you.” [His Apple Watch buzzes.]

You can go ahead and check that.

It’s my son. [Speaking into watch.] We’ll do a late lunch. Don’t worry about it. Go ahead and have fun. [Back to the interview.] He’s playing basketball.

Nice.

So, with the PBMs, there’s no negotiation. Particularly for the small independent pharmacies, they take it or leave it. And: “Oh, by the way, you are not allowed to say anything about this contract at all.” Period. The number one rule of health care contracts is you don’t talk about health care contracts. So instead of breaking even, the pharmacy might lose $20 to $30 on every brand subscription they’re doing. The idea is, they’ll make it up on toilet paper and other stuff. Well, that doesn’t work.

And the drug manufacturer?

The PBMs also negotiate with the manufacturers, but they lose out as well. They have no idea who is using their medications, what the demographics are, what the adherence is. So the PBM will offer to do analysis for them, and then sell the manufacturer access to the data for their own drug.

Then the trade association for the PBM says, “Look at the bad guys!” It’s so convoluted and opaque.

[Greg Lopes, a spokesperson for the Pharmaceutical Care Management Association, a trade group, told WIRED, “PBMs have a proven track record of securing savings on prescription drugs for patients.” He added that drug companies “are solely responsible for setting and raising prescription drug prices.”]

OK, so you saw how these entities bought up drugs and controlled the market. Why didn’t you, a billionaire, take that approach with other drugs? Why didn’t you say, I’m going to buy all the insulin in America?

Well, we looked at manufacturing insulin. We developed our own glargine [synthetic] insulin, and I spent $5 million or more, I don’t even know. But that was right when Biden made sure Medicare plans were covering insulin for up to a $35 copay. So it made no sense to do it at that point.

You told Texas Monthly that you don’t care if you don’t make a fortune off of this. Is that still true?

I want to make it so it’s self-sustained. I don’t want to subsidize it the whole time. But I don’t need to make money.

Do you see Cost Plus Drugs as altruistic?

No. I see it as fun with a huge impact. Altruism is like, “Great, I feel good because I’m helping people. I gave money and da-da-da-da-da.” Disrupting an industry that everybody hates, that’s fun. I’m getting emails and letters, if not every week, every two weeks, saying, “Oh my God, my grandma’s alive.” I just got a note from someone who wrote, “You saved me $15,000 a year on my cancer medication. I would be dead if it weren’t for you.”

What’s interesting is—and I’m not going to say midlife crisis—it does seem like you’re at least thinking about your legacy now.

But if I was 25 and this opportunity came up—

You’d still do it.

I’d do the same thing. The difference is I would probably try to make as much money as I could because I’m only 25 and I’m trying to establish myself. Now I don’t need the money. My next dollar is not going to change my kids’ kids’ kids’ kids’ life.

But it does take a lot of time and emotional energy. It takes a lot of work to learn all this in a few years, enough to turn a whole industry around. That’s what people are most surprised about. I walk in the door and I’m telling the CEO of a major company, “You’re an idiot because I’ve studied your business and here’s what’s wrong.” [The waiter arrives with our food.]

Thank you so much. See, the other part of this is I track everything I eat in MyFitnessPal. I think my streak is up to 3,600 days.

How big do you want Cost Plus Drugs to be? How are you thinking about scale?

We’ll sell every drug we’re legally allowed to sell. But scale isn’t so much about size, it’s about disruption. If I do my job, that means we’ve disintermediated those PBMs.

What about the part of your business that manufactures drugs, will you grow that?

We manufacture drugs that are on the FDA shortage list and are injectables. There’s an FDA drug-shortage list that hospitals can’t access but the companies can, so they jack up the price.

How are you approaching GLP-1 drugs, like Ozempic and Wegovy?

OK, so that’s an interesting question, because GLP-1s are on the shortage list. As long as the patents are valid, there’s a rule that says if it’s on the shortage list, you’re allowed to make it. So companies can manufacture them, and that’s why you see some companies starting to sell them at a lower price now.

That’s also why you see some GLP-1 makers invest huge amounts to expand their capacity, because they don’t want to be on the shortage list. It’s unlikely those drugs will stay on the shortage list for long, so we don’t make them.

I have to imagine manufacturing your own drugs from scratch is like making silicon chips—a multiyear, multibillion-dollar investment to spin up your fabs.

Same thing. It’s multiyear. It’s not multi-billion, but it’s all robotically driven. Right now our capacity is about 2 million vials a year.

How long are you going to stay with this?

Until it’s fixed. I want to say I fixed the health care system. Can I do it? Maybe. Is it 100 percent? No. Is it greater than 1 percent? Greater than zero? Yes.

On the Trevor Noah podcast, you talked about how if you’d done something else in life you’d probably still be successful because of your work ethic and curiosity. But you’ve also gotten incredibly lucky.

And I’ll be incredibly lucky here too.

Do you think we should have billionaires?

Yeah, of course.

Why?

Everything’s relative. “Millionaire” used to be inconceivable. When I became a billionaire, a company with a $5 billion or $10 billion valuation was huge. Now there are trillion-dollar companies. And I guarantee you, those people are going to be a lot smarter than the government.

The billionaires are?

The 1 percent who figure it out and are able to create something that’s of value, yes. There’s Atlas Shrugged for a reason. “Who is John Galt?” was a saying for a reason. There’s a point of diminishing returns. Those people in a position to make something or build something, whatever it may be, aren’t going to all of a sudden say, “Well, it’s OK that I can’t be rewarded for that.”

As an entrepreneur, I can create things and get rewarded and reinvest in other companies, like I did with Cost Plus Drugs. So while the money seems obscene in a lot of respects—and I understand that completely, I couldn’t even spend the money that I have—without it I couldn’t invest in the things that I invest in, the hundreds of entrepreneurs that I have backed. I couldn’t do Cost Plus Drugs.

Do you think that billionaires should be taxed more than they are now?

Not on unearned income or on capital gains.

The majority of Americans support a wealth tax on the very rich. It’s one of the few things that people are aligned on.

If there’s a net-worth tax there would be no Cost Plus Drugs, because I wouldn’t know what my tax is next year.

Could you pay your taxes either way? You shared a tweet in April that showed you owed $275,900,000 in taxes this year.

I couldn’t. Because who carries that much cash?

Are you still a libertarian?

Not so much anymore.

Why is that?

Things change. This country has 110 million more people than it did in 1980. And there are all these policies that have been put in place.

Would I like less government? Yeah, I would like less government. Would I like a smarter government? Even more so. Would I love to see government as a service so fewer people have to do the same bureaucratic work over and over again? Do I think AI will be smarter than 99 percent of these people doing the rote bureaucratic work? Yes, I do. Do I wish that we had anybody who understood that and was trying to propose it and implement it? Yes. That’s part of being a libertarian.

But you can’t go from where we are to there, in a direct line. It’s impossible.

And you’ve said you’re not going to run for office.

No, hell no.

Why not?

Who would put themselves through that? I can do more from the private sector. You can’t be president and change health care. You’ve got to get Congress behind you, and this, and that. As an entrepreneur, you can change anything. Jensen Huang, what he’s doing with Nvidia, he can pretty much define what’s going to happen by how he prices things.

Do you think Nvidia’s at its top?

Not yet.

I know you don’t want to talk about Elon, but you’ve been pretty outspoken against some of his ideas around DEI. What drives you to speak? You know the reaction you’re going to get on Twitter.

That’s the whole point. It wasn’t an Elon issue, it was a platform issue.

Explain that.

He who controls the algorithm controls the platform—controls that world, that community. And Elon has built, X has built, a very strong right-leaning community. They’re fun to fuck with.

That doesn’t seem exactly like the best reasoning for speaking out about diversity and inclusion.

I’m not just taking a position to fuck with them. It’s something I believe in. But at the same time … look, I don’t do a whole lot of interviews. During the last election cycle, I didn’t do a lot on CNN or MSNBC. I did a bunch on Fox. I don’t need to preach to the converted.

It seemed like you went out of your way to say that you’re not hiring solely based on diversity.

No, you can’t. You can’t hire less qualified people, because that’s business suicide. But you can go out and find the really, really smart people who aren’t being discovered. That’s the mission: to look where other people are not. Because there’s some kid that’s smart as fuck, that’s living in an urban area that may not have the same opportunities as other people. And no one’s looking for him. You should look for him. That’s always the best reason.

You mentioned that AI will affect drug manufacturing and rote bureaucratic jobs, but it’s also changing hiring, right? AI is going to screen people. It’s supposedly smarter, but it could be discriminatory too. How are you thinking about AI?

So I’ll give you an analogy. Who would you trust more to take you three blocks, a Seeing Eye dog or a full-service, self-driving car?

Google Maps.

Well, no. If you were blind, let’s say.

Oh, a full self-driving car. I actually really like the self-driving cars. I take them in San Francisco.

I would trust the dog.

Why?

Because a dog can sense issues. Nothing about a self-driving car understands what’s adversarial or not. If it hasn’t seen it, it has no idea. Whereas a dog is going to understand. Take a puppy. We have a mini Australian shepherd. I can take Tucks and just drop him in a situation, and he’ll figure it out quick. I take a phone with AI and show it a video, it’s not going to have a clue. And I don’t think that’s going to change for a long time.

How long?

Ten years.

Why do you think that is?

Because wisdom doesn’t come with text.

I literally just saw you do an ad for Google’s Gemini AI tool.

It helped promote Cost Plus Drugs. That’s all I care about.

But in more consequential scenarios, you think AI has a long way to go.

I think smart puppies are smarter than AI is today or in the near future.

So when you look at companies like OpenAI, do you think they’re overhyped?

Not at this point. I don’t think any of them are overhyped. But a lot of things are going to change. The processors are super expensive. They’re not going to be super expensive forever. The efficiency of training and building models is going to change. Everybody’s going to have their own model. There’s going to be millions and millions and millions. Lauren will have her own model.

Everybody’s going to be immortal in a certain sense. So if you keep all your emails and interviews, or your parents keep it for you from the time you’re a kid—your first-grade papers, your pictures, all the things kids do—now you have little Lauren LLM. By the time Lauren’s 11, that’s probably going to be her best friend.

I do think building an AI version of yourself is increasingly going to become a part of people’s end-of-life planning or legacy thinking. But I also think it gives us a bit of main character syndrome. As I think about my own life, do I need that stuff? Does anyone?

It’s not that you need it. But look at social media. Everybody’s already a brand.

Right, we all think about how we’re going to be perceived, but is that a good thing?

In the big picture, no. Particularly not for kids. With my kids, there is no balance. That’s all they know. Would I prefer they didn’t have that? Yes. Just because playing and going outside and connecting is different.

Yeah. Our curiosity had to be fed in different ways.

That’s the right way to put it.

And I had a lot more alone time, which I kind of liked.

You might’ve read. I used to read a lot, and tried to teach myself the guitar.

And I played basketball for years and years. That was a community.

And so, now …

Very online.

Yup.

You said something once about how the boomer generation—

Yeah, how it was a disappointment.

Had a good rep for a while.

Sex, drugs, and rock and roll was a great start. And protesting the Vietnam War.

And now you call it the Fox News generation. I’m wondering if you think there is an antidote to that.

You buy Fox News.

Would you do that?

If I had enough money to do it, which I don’t, I’d buy it in a heartbeat.

Explain that to the readers, who are like, how does he not have enough to buy Fox?

What’s the market cap of Fox?

Let’s see. Well, you’d also have the whole Murdoch heir thing to deal with. But putting that aside, it’s $15.6 billion right now.

And you’ve got to pay at least 50 percent premium. So now it’s $22 billion. And then you’ve got to make all the changes, so that’s another $2 billion. You can sell some things off. So maybe it’s $15 billion, $20 billion net. I don’t have $15 or $20 billion in cash sitting around.

Short of buying it yourself then, how would you fix something essentially like propaganda?

Too late.

That’s dire. Why don’t you buy Twitter?

He wouldn’t sell it.

What if you convinced him it was his idea?

I wouldn’t know how to do that.

Would you, in a perfect world, consider buying Twitter?

Yeah, for sure.

Would you please, for the love of God, buy Twitter?

I wish I could. There’s no reason for him to sell it.

What have you been wrong about?

Oh, a lot.

I remember at least two things from when I interviewed you many years ago. One, you were big on movie theaters. It was after the financial crisis, and you were sure people were going to come back to theaters. You owned Landmark. Do you still own that?

No, I sold it. Before the pandemic. Thank God.

Smart.

Lucky.

We also talked about 3D and home theater, and you were bullish on it. I never really thought people were going to sit at home with 3D glasses on.

No, I don’t think I was … I liked it as a value add, right? I thought it created a new entry point for people to buy something. I didn’t think it was going to revolutionize anything.

OK, so, bigger things: What have you been wrong about?

Donald Trump. I thought there was no chance he’d get elected.

Why did you think there was no chance?

Because I know the guy.

Do you think he’s going to win again?

I hope not. I don’t think this election is about policy at all. I think it’s about trust and comfort, and that’s why the double haters—people who don’t like Trump or Biden—are now going to go for Kamala. She and Walz are both somebody that if, you know, you invited them to dinner, it would be a comfortable, fun family dinner, right? You wouldn’t feel threatened. You can’t say that about Donald Trump.

You’ve said before you don’t give money to PACs or politicians. Is that still the case?

Correct. I’m helping Harris vocally. But I do think she’s going to have to swing more moderate on certain issues.

Like what?

Like crypto.

What about gun laws? Or abortion rights?

I’m talking only on the financial side. And the reason I think crypto is so important is—look, I’ve seen a variety of surveys, so who knows exactly what’s right. But kids under the age of 40—let’s say kids, even though they’re adults—a lot of them own crypto.

But infinitesimal amounts?

That’s the whole point. You put up 50 bucks, 20 bucks, 10 bucks and you buy some dogecoin or bitcoin, and that’s kind of your lottery ticket that you’re hoping will increase your net worth, because you can’t save money elsewhere. When I was a kid, we collected comic books and baseball cards. It was fun to get your Superman comic and talk to your friends about it. But you knew, because you’d heard the stories, that the original Superman comic book was eventually worth $10,000, and so you’re thinking, wow, this could be worth something.

Now, in today’s age, you download an app, you get on Reddit, you’re part of that community. If dogecoin went from less than a penny to $0.18, and you’ve bought $10 worth, that’s a substantial change to your net worth as a 20-year-old kid living at home with your parents. Let’s say some material percentage are people of color and they don’t have as many opportunities. They’re not in the banking system. And now someone [in the government] says, “Nope, those are all securities, and we’re going to make all that worthless,” well, that’s going to affect them.

You were pro-FTX.

I wasn’t pro-FTX. I thought Sam [Bankman-Fried] was smart. I didn’t talk to him that much. I talked to him one time.

And you didn’t get any vibes?

I never met him personally or anything like that. But as big of a crook as he turned out to be, if the SEC had put in the same collateral requirements and separation of funds requirements that Japan has, he wouldn’t have been able to steal it.

What’s your biggest concern about Donald Trump?

When I talk to Trumpers, I’m like, “Look, the guy rips off hard-working Americans and takes pride in it. Is that who you want? The guy doesn’t believe in climate change. Are you 100 percent certain about climate change? No? Well maybe there’s a 1 percent chance. Are you willing to take a 1 percent chance that your kids are fucked, your grandkids are fucked?”

Is there anything that makes you feel your own mortality these days?

Oh, yeah. Every day that I wake up and I’m sore. I do the whole thing, I get my blood checked every three or four months, and that gives me benchmarks. But it makes me feel my mortality, for sure. You get older. Your parents die. Mortality is all around you.

But one thing I learned from my dad: When you hit 40, you think you’re old. When you hit 50, you think you’re old. When you hit 60, you think you’re old. But when you look back at 40 …

Looks pretty good.

It looks really good. So that’s kind of the attitude I take. When I hit 80, I’m going to say … 60 looked really, really, really good.

Maybe the reason I keep asking about a midlife crisis is because maybe I’m having one. And maybe we shouldn’t call it a crisis anymore.

Yeah, I mean, you can call it whatever you want, but at various points in your life you go through that.

For me, right now, I don’t need to be more famous. I don’t need to be wealthier. Now I think more about my kids and their health and what could go wrong there, which terrifies me every day. It’s not so much my own mortality that scares me. It’s the people I love.

You can get past your own midlife crisis, your own mortality. Because you get to the point where you realize, “Hey, if I have 20 years left, 30 years left, that’s good—and I’m not going to fuck it up.”

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