Cost Plus Drugs co-founder Mark Cuban is not convinced the Federal Trade Commission’s settlement with Cigna’s Express Scripts is going to amount to much.
“My initial response to the FTC [and pharmacy benefit manager] settlements … meh. [G]reat intent. [W]ill not accomplish the goal,” Mr. Cuban said Feb. 4 on LinkedIn.
The settlement calls for a “standard offering to plan sponsors” that encompasses reforms, such as ensuring out-of-pocket costs are based on the drug’s net unit cost and access to an insulin savings program. This standard offering would be available to all plan sponsors.
Mr. Cuban’s main concern: “If the PBM convinces the employer to choose the current system, then they can do it just the way they always have.” In other words, the standard offering is not universal — it is just an option.
“Would anyone be shocked if consultants and brokers got bonuses for using last year’s contracts?” he said. Mr. Cuban also argued that confidentiality clauses can remain intact under the agreement. A recently proposed Labor Department regulation could alleviate some confidentiality pressures within fiduciary relationships.
Mr. Cuban expressed concern over what the settlement does not directly address: rebate “float” — the value PBMs can gain by holding onto rebate dollars over time — and reliance on wholesale acquisition cost.
Instead, Mr. Cuban proposed having manufacturers sell drugs to wholesalers at net price, preventing inflated list prices and rebate issues downstream.
“If you require wholesalers to work at net, then rebates can’t be added back in, cash out of pocket for everyone is at net, and it’s a lot easier to find and track where the big insurance companies are ripping off patients, pharmacies and sponsors,” he said.
Mark Cuban joins Becker’s Spring 2026 Chief Pharmacy Officer Summit on Wednesday, April 15. For more information and to apply for complimentary participation, click here.
