Pharmacy & drug pricing · Generic medicines
Mark Cuban Cost Plus Drug Company
A Dallas public benefit corporation that publishes what it pays for every generic drug it sells, adds a fixed 15 percent, and now fills sterile injectables of its own. Independent researchers have measured both what the model exposes and what it fails to fix.
The weekend that started it
Alex Oshmyansky was a radiology trainee at Johns Hopkins when a pulmonologist he worked with came in furious. Two of that doctor’s patients had died over the same weekend. Both needed bosentan. Both were meant to get it through a manufacturer’s assistance program. Both got caught in the paperwork. The drug was long off patent and cost about $10,000 a month.
In 2015, after Martin Shkreli raised the price of pyrimethamine by more than 5,000 percent, Oshmyansky and some physician friends set up a nonprofit to make drugs and sell them at cost. He spent years trying to fund it and, by his own account, “raised $0 beyond what I put in myself.”
Y Combinator mentors told him a nonprofit would never raise what he needed and suggested a public benefit corporation. He refounded in 2018 as Osh’s Affordable Pharmaceuticals, went through the S18 batch, and sent a cold email to Mark Cuban.
What the email was about
The pitch was not about pharmacies. It was about a market where nobody can see a price. Drugs move manufacturer to wholesaler to pharmacy, but the money moves through pharmacy benefit managers that negotiate for insurers and are typically paid a share of the discount they extract. The higher the starting price, the larger the discount, the larger the fee. Three PBMs handled 79 percent of US prescription claims in 2020.
Oshmyansky’s standing example is imatinib. List price around $10,000 a month. Adjudicated through a high deductible plan, $2,000 to $3,200. On his site, $39. Generics are about 90 percent of US prescriptions, and that is the surface the company chose.
Cuban put his name on it
Cuban answered, invested in November 2018, and kept raising his stake until he wanted his name on a company for the first time in his career. Oshmyansky stayed as founder and chief executive. The pharmacy opened on January 19, 2022 with about 100 generics at acquisition cost plus a 15 percent margin, a $3 pharmacy fee and $5 shipping; by 2026 those fees were $5 and $5.25. Asked at the University of Pennsylvania in 2024 whether he could have moved this fast without a personal fortune, Cuban said no.
Then they built a factory
In February 2021 the company filed a permit for an $11 million, 22,000 square foot plant in Deep Ellum, and registered it with the FDA as a 503B outsourcing facility on November 2, 2022. It is fill and finish, not chemical synthesis: sterile product into vials under robotic handling, on lines built to switch drugs fast enough to chase shortages.
Commercial production began in March 2024, announced by Oshmyansky at a White House roundtable, starting with epinephrine and norepinephrine in hospital vial sizes. A wholesale arm called Marketplace opened the same year. Community Health Systems took shipments to nine hospitals in March 2024, then extended across all 71; ScionHealth followed in May across 94.
Retail spread differently. A Team Cuban Card launched with 36 independent pharmacies in 2023 and, the company says, reached more than 17,000 locations by late 2025. Capital Blue Cross was the first health plan partner in early 2023. In May 2026 the federal TrumpRx site added more than 600 generics and began routing some searches to Cost Plus.
What is proven, and what is still claimed
| Evidence | What the record shows | Source type |
|---|---|---|
| Medicare Part D savings | Lalani, Kesselheim and Rome, Annals of Internal Medicine, Jun 21, 2022. Reporting at publication put the estimate at $3.6 billion on 77 generic drugs, 2020 utilization. The article was corrected on Jul 8, 2022 after errors in matching drug formulation and strength; later authors cite it as over $3 billion. | Peer reviewed |
| Subspecialty savings | PharmacoEconomics, Aug 2024: $8.6 billion estimated Part D savings at 90 day pricing, nearly 80 percent of drugs examined cheaper. Journal of Clinical Oncology, 2023: $661.8 million, 78.8 percent, on seven generic oncology drugs. Journal of Urology, Feb 2023: about $1.29 billion in 2020. | Peer reviewed |
| What patients save | JAMA Health Forum, Jun 2024, 2019 MEPS data against March 2023 prices, 124 generics: 11.8 percent of weighted fills would have cost less, median $4.96. Uninsured 28.9 percent, Medicare 5.5, private 7.1, Medicaid none. | Peer reviewed |
| Commercially insured | Annals of Internal Medicine, May 26, 2026, Lin and colleagues, 62 million 2024 claims against 2025 prices: cheaper on only 15 percent of prescriptions, median $6. Above $15 of cost sharing it won about 80 percent of the time; above $100, $140 insured against $25 direct. | Peer reviewed |
| Expensive generics gap | Journal of General Internal Medicine, Feb 2024: one in five of the 100 most expensive generics was unavailable at any of five direct to consumer pharmacies. Cost Plus had the lowest price on 26 percent of available expensive generics, 10 percent of common ones. | Peer reviewed |
| FDA registration | Listed as Mark Cuban Cost Plus Manufacturing and Compounding, LLC, Dallas, TX, contact Alexander Oshmyansky. Initial registration Nov 2, 2022, most recent Dec 14, 2024, last inspection Jan 28, 2026, Form 483 issued, no recall. | Public record |
| Form 483, Sep 6, 2024 | Nine day inspection, FEI 3024611767. Seven observations: aseptic gloving and disinfection, exposed sprinkler heads in the ISO 7 filling room, uncleaned computers in cleanrooms, a power failure logged as no deviation, monitoring gaps, miglustat labeling, and no product report filed at registration. | Public record |
| After the inspection | FDA lists a regulatory meeting on Mar 26, 2025 and an FMD-145 letter on Jun 5, 2025. No warning letter or recall is listed. | Public record |
| Coherus dispute | Coherus BioSciences 8-K, Jun 15, 2023: AbbVie alleged a license breach over the Cost Plus pricing agreement for its Humira biosimilar. Coherus denied it, sought a restraining order in Delaware Chancery, and the parties stipulated on Jun 14. | Public record |
| Federal program | Named in May 2025 as one of four Equip-A-Pharma partners with HHS and DARPA, each expected to file an abbreviated new drug application within a year. None reported. | Independent |
| Scale | Two million customer accounts within 13 months; roughly 4,000 medications as of April 2026. No revenue disclosed. | Company-stated |
| Securities filings | No SEC registrant and no Form D under any Cost Plus or Osh name in EDGAR as of Sep 23, 2026. | Not found |
Read plainly: the system level finding is repeated and solid. Across Part D, oncology, urology and surgery, independent teams keep reaching the same conclusion, that payers pay far more for generic molecules than a transparent cash price requires. The patient level finding is narrower. Most insured people, most of the time, do better using their benefit. The company wins where cost sharing is already high, or where there is no insurance.
What to watch
- Whether an abbreviated new drug application from the Equip-A-Pharma work reaches the FDA, moving the company from filling vials to owning approvals.
- The outcome of the January 28, 2026 inspection, after a 2024 visit that produced seven observations.
- Whether any study measures realized rather than modeled savings. Every published estimate so far is counterfactual pricing, not observed switching.
- Whether Marketplace breaks into hospital purchasing at scale. Cuban says the barrier is group purchasing contracts, not price.
- A first Form D, which would signal outside capital entering a company that has run on one balance sheet.
In their words
“People used to call me Doc Quixote, tilting at windmills.”
Alex Oshmyansky, co-founder and CEO, D Magazine, 2022 · Independent
“The path is incredibly complicated. It’s very convoluted and that’s by design.”
Alex Oshmyansky, on the drug supply chain, The Patient Story, 2022 · Interview
“No parent should be told the chemotherapy their child needs is not available,”
Alex Oshmyansky, White House roundtable, reported by Fortune, March 2024 · Independent
“This industry is the easiest industry I’ve ever disrupted”
Mark Cuban, to Ezekiel Emanuel at the University of Pennsylvania, Penn LDI, December 2024 · Independent
“Our ultimate product isn’t drugs, it’s trust. Trust equals transparency, divided by self interest.”
Mark Cuban, Becker’s Chief Pharmacy Officer Summit, April 2026 · Company-stated
“With generic drugs constituting 90% of all dispensed prescriptions, some patients can benefit from a transparent cost-plus pharmacy pricing model; however, for most, it is less expensive to use their health insurance benefits.”
Kouzy and colleagues, JAMA Health Forum, June 2024 · Peer reviewed
“It wasn’t true that you could always go to Costco, or you could always go to Mark Cuban’s pharmacy, and that would always have the lowest price,”
Benjamin Rome, MD, MPH, Brigham and Women’s Hospital, to MedPage Today, February 2024 · Independent
Related companies
Sources
- Public recordFDA Form 483, Mark Cuban Cost Plus Manufacturing and Compounding LLC
- Public recordRegistered Outsourcing Facilities table
- Public recordCoherus BioSciences Form 8-K
- Peer reviewedPotential Medicare Part D Savings on Generic Drugs From the Mark Cuban Cost Plus Drug Company, with correction
- Peer reviewedPatient-Level Savings on Generic Drugs Through the Mark Cuban Cost Plus Drug Company
- Peer reviewedProjected Savings for Generic Oncology Drugs via Mark Cuban Cost Plus Drug Company
- Peer reviewedDrug Pricing Stewardship from Mark Cuban’s Cost Plus Generic Drug Program
- IndependentCost Plus Drugs Beats Commercial Insurance Co-Pays 80% of the Time
- IndependentMark Cuban Explains His Battle Against Pharmacy Benefit Managers
- IndependentExpensive Generics: Where Direct-to-Consumer Pharmacies Fall Short
- IndependentMeet the Genius Who Convinced Mark Cuban to Sell Drugs
- IndependentCost Plus Drugs will begin manufacturing its own medications this week
- IndependentMark Cuban’s healthcare playbook, explained
- IndependentHow a Dallas doctor teamed up with Mark Cuban
- InterviewAlex Oshmyansky on drug pricing and the path from pharma to patient
Profile researched and written by Healthcare Discovery. Last updated September 29, 2026.
