For a billionaire, another dollar might not change much. For someone struggling to afford prescription medication, the cost of treatment can make the difference between getting care and going without it. Cost Plus Drugs co-founder Mark Cuban says that gap is at the heart of his company’s mission.
"People are like, ‘Well, you’re a rich guy. You’re just trying to make money,’" Cuban said on the "unPAUSED" podcast in October.
"No, my next dollar is not going to change my life, but my next dollar might save somebody’s life, and that’s the way we look at it at Cost Plus," Cuban told host Dr. Mary Claire Haver.
Haver, a board-certified obstetrician-gynecologist and certified menopause practitioner, spoke with Cuban about the estrogen patch shortage, prescription drug pricing and the challenges women face when trying to access affordable hormone therapy.
Why Estrogen Patches Are Running Short
Haver held up her own estrogen patch during the interview and asked Cuban why the medication had become so difficult for women to find and afford.
Cuban said prescriptions for estrogen patches had nearly tripled over two years, while demand at Cost Plus Drugs had increased at least tenfold.
Manufacturing is part of the problem. Oral estrogen is relatively straightforward to produce, but patches require specialized equipment and processes that many generic drugmakers don’t have. When demand rises faster than production capacity, supplies can quickly fall short.
Cuban attributed the surge in demand partly to changes in how menopausal hormone therapy is viewed after the FDA removed the boxed warning on hormone therapy. He said Cost Plus has been purchasing as much inventory as manufacturers can produce and has approached suppliers about buying their entire available output.
The Price Behind a $39 Estradiol Patch
Cost Plus Drugs launched in 2022 with a pricing model designed to show customers medication acquisition costs and add a 15% markup, along with pharmacy and shipping fees.
During the interview, Haver pulled up the company’s website to examine a generic estradiol patch. The listed manufacturing cost was $29.72. After the markup, pharmacy labor and shipping, the total came to roughly $39.18.
Cuban said Cost Plus sometimes turns to a more expensive version from another manufacturer when supplies are tight, provided the medication can still be offered at a competitive price.
He also pointed to estrogen cream as an example of how generic medications can be made more affordable. Some products that cost patients substantially more through traditional retail channels may be available for less through Cost Plus, depending on the formulation and price.
The company’s approach doesn’t eliminate shortages or guarantee that every medication will always be available. Its focus is on making pricing more transparent while securing as much supply as manufacturers can provide.
The Funding Gap in Women’s Health
The interview also addressed the longstanding shortfall in women’s health research. Haver cited figures indicating that less than 9% of National Institutes of Health grant funding over the previous decade went specifically to women’s health.
When Haver asked Cuban why he believed that gap persisted, he replied, "It’s run by men."
Cuban argued that institutions often stick with familiar practices rather than confronting systemic problems. He said entrepreneurs look for broken systems because those failures can reveal opportunities for change. He also credited physician Rachel Rubin with helping him recognize barriers to affordable estrogen cream and hormone therapy.
Transparency is central to the Cost Plus model. Publishing acquisition costs and a defined markup gives customers a clearer view of how medication prices are calculated.
The conversation also covered pharmacy benefit managers, rebates that can influence drug list prices, and ways patients can compare cash prices with insurance copays. The broader issue is whether people can obtain the medications they need without cost becoming a barrier to treatment.
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