Billionaire entrepreneur and healthcare company founder Mark Cuban said that pharmacy benefit managers (PBMs) are expanding their role in healthcare decision-making, writing in a post on X that the shift could give intermediaries greater control over employer healthcare spending.
The topic is significant as PBMs play a central role in negotiating drug prices and managing formularies for employer and government health plans. According to KFF, lawmakers from both parties have increased scrutiny of PBM practices in recent years, holding hearings and proposing legislation focused on transparency, pricing structures, and market competition within the pharmaceutical supply chain according to KFF.
In his post, Cuban said there is a growing expansion of PBMs beyond traditional prescription drug administration into clinical management and care-navigation services. He said PBM-affiliated entities increasingly offer programs such as specialty drug management, prior authorization administration, care navigation, and digital health services, often charging employers per-employee or per-member monthly fees tied to treatment oversight and utilization management according to his post on X.
“The new PBM scam is to control care decisions. Whoever controls care decisions controls your benefits budget, and it won’t be you. It will be your PBM. You have been warned,” Cuban wrote.
In the same post, Cuban wrote that these services allow PBMs or related vendors to influence how care is delivered by managing clinical programs, tracking outcomes connected to manufacturer agreements, and providing analytics and reporting tools used by employer health plans. He wrote that when organizations administering pharmacy benefits also participate in care-management decisions, they can shape healthcare spending outcomes because those decisions directly affect employer benefits budgets according to his statement.
A Georgia House committee presentation cited an example where a multiple-sclerosis drug with a National Average Drug Acquisition Cost (NADAC) of $220.60 had an average Georgia Medicaid payment of $3,966 in 2021—an illustration of how large spreads or markups can inflate costs in public programs when pricing is opaque as reported by the Georgia House committee.
Cuban co-founded the Mark Cuban Cost Plus Drug Company in 2022. He previously founded Broadcast.com—which was sold to Yahoo in 1999—and owns stakes including the Dallas Mavericks according to his biography.
