Mark Cuban, from the long-running show “Shark Tank,” is one of the most well-known figures in startup funding and venture capital. So, when he was asked what a company should do if it needs to raise funding, many would be surprised to hear his answer. “The quickest way to raise money if you have over 100 employees and self-insure is to change your health care program and, in particular, your pharmacy benefit manager,” Cuban said. He continued, “That's immediate cash in the bank.”
Cuban has argued for years that America's drug pricing system makes patients pay the highest price, and this version of the argument was aimed at employers rather than patients.
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A pharmacy benefit manager (PBM) sits between an employer, the pharmacy, and the drugmaker. It builds the list of covered drugs, negotiates rebates with manufacturers, sets pharmacy pay rates, and processes claims. For a self-insured employer, one that pays its workers' medical bills out of its own money and hires an insurer only to administer the plan, the PBM contract is a direct cost line rather than something buried inside a premium. That is the money Cuban was pointing at.
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Cuban co-founded Cost Plus Drugs, which sells drugs on a disclosed markup and competes with the incumbents he is telling employers to replace. His circumstances have also moved since the interview: a White House fact sheet in May 2026 listed Cost Plus Drugs among the discount providers integrated into the government's TrumpRx site, and Barchart covered his decision to work with TrumpRx at the time.
The concentration he is describing is real. In its July 2024 interim staff report, the Federal Trade Commission found that “the top three PBMs processed nearly 80 percent of the approximately 6.6 billion prescriptions dispensed by U.S. pharmacies in 2023, while the top six PBMs processed more than 90 percent.” The same report found pharmacies affiliated with the three largest PBMs account for nearly 70% of all specialty drug revenue.
Most readers will not recognize the three by name, because they are owned by companies they know better. CVS Caremark belongs to CVS Health (CVS). Express Scripts sits inside Evernorth at Cigna (CI). Optum Rx is a reportable segment of UnitedHealth Group (UNH), which disclosed that it managed $188 billion in pharmaceutical spending in 2025. Anyone holding a broad index fund owns a piece of all three.
Cuban has often paired the claim with a figure of roughly 155 million people covered by self-insured employers. KFF's 2025 employer survey found 67% of covered workers enrolled in self-funded plans, ranging from 27% at firms with 10 to 199 workers to 80% at larger ones. Separately, KFF puts total employer-sponsored coverage at 154 million people under 65, a figure that counts dependents and comes from census data rather than the employer survey.
That distinction matters for who the advice applies to. The self-funded share is 27% among employers with 10 to 199 workers, so a company just over Cuban's hundred-employee threshold is more likely than not to be fully insured, in which case the PBM contract is not its to renegotiate. The advice is aimed squarely at the larger end, where 80% of covered workers are in self-funded plans.
What has changed since the interview is enforcement, not structure. The FTC brought a case over insulin pricing against all three of the largest PBMs; Express Scripts settled in February 2026 and Caremark in July 2026, with the matter against Optum Rx still pending. None of that establishes that concentration alone is unlawful, and the FTC's interim reports describe market structure rather than wrongdoing.
On the date of publication, Caleb Naysmith did not have (either directly or indirectly) positions in any of the securities mentioned in this article. All information and data in this article is solely for informational purposes. For more information please view the Barchart Disclosure Policy here.
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