A report comparing the Mark Cuban Cost Plus Drug Company (MCCPDC) to copayments or coinsurance under employer-sponsored insurance found that patients with high-cost generic prescriptions could lower their out-of-pocket costs from $140 to $25 by bypassing their insurance and using MCCPDC. Savings were frequent (nearly 80%) for any generic whose copayment or coinsurance exceeded $15. The study is published in Annals of Internal Medicine.
Researchers led by John Lin, M.D., assistant professor of health services research at The University of Texas MD Anderson Cancer Center and Jenny Xiang, M.D., assistant professor of medical oncology at The University of Colorado Cancer Center matched copayment or coinsurance amounts for filled generic prescription claims between January 2024 through January 2025 with direct purchase prices in 2025 through the MCCPDC. They calculated the frequency and extent of savings through the MCCPDC, stratified by prescription out-of-pocket cost categories, and identified disease areas where high out-of-pocket costs were frequent. Directly purchasing through the MCCPDC did not yield large savings for most prescriptions, where out-of-pocket costs were already low. However, they found that among generics with cost sharing of more than $15, nearly 80% of prescriptions would have had lower out-of-pocket costs had they been purchased through MCCPDC. For generics with a cost sharing of more than $100, median out-of-pocket costs were $25 through the MCCPDC compared to $140 through insurance. Additionally, disease areas with drugs that had higher cost sharing include oncology, urology, psychiatry, neurology, cardiology, and transplant.
Prescription affordability in the United States is an issue patients face, even for those who are insured. The researchers conclude that patients with employer-sponsored insurance facing affordability challenges with their generics should consider DTC pharmacies whenever their prescription’s copayment or coinsurance exceeds $15. They should particularly consider DTC pharmacies for drugs with higher out-of-pocket costs.
