Editorial

Take That, Pharma Bros

Deval (Reshma) PaRanjPe, mD, mBa, FaCs

Hometown boy makes good”. “ I’m talking about famous Pittsburgh export and billionaire

Mark Cuban’s latest venture, Cost

Plus Drugs, a national online pharmacy which promises generic drugs priced strictly at cost plus 15% markup and pharmacist fee. The pharmacy doesn’t accept insurance, so patients pay directly. Patients can purchase medications outright with a prescription, and the prices are often far less than the copays they would ordinarily pay using their insurance.

Cost Plus Drugs has also established its own pharmacy benefit manager and is building a Dallas production facility to manufacture its own generics in the US. Cost Plus Drugs ships to all 50 states.

Radiologist and child prodigy Alex Oshmyansky MD, Ph.D. is the inventor and CEO of Cost Plus. Oshymyansky pitched Cost Plus Drugs to Cuban, who believed and invested in the concept. The aim is to reduce the cost and thereby expand access to lifesaving prescription drugs upon which many Americans depend. Cost Plus negotiates directly with manufacturers, bypassing middlemen and pharmacy benefit managers. This represents a massive disruption to a prescription drug industry which has made significant and onerous markups routine.

The most notorious example of outrageous markups in recent years was the doing of so-called “Pharma Bro” Martin Shkreli, who in 2015 acquired the manufacturing license for Daraprim and raised the price 56x, from $13.50 to $750 per tablet.

Not to be outdone, Mallinckrodt Pharmaceuticals acquired and raised the price of corticotropin, a drug invented in 1952, from $40 per vial in 2000 to around $40,000 per vial today under the brand name Acthar Gel. Both drugs are vital and life-saving—the former is an antiparasitic agent and the latter an anti-seizure agent. The intent of the acquisitions and price hikes in both cases was to make the drug in question a massive “cash cow” for the pharmaceutical company. However, patients who needed these drugs for their very survival suddenly found themselves being bankrupted and/or at risk of dying.

Some of the savings that Cost Plus offers are modest. Some are astounding. Atorvastatin, which retails for $55.80, is only $3.60 for a 30day supply. Imatinib, the generic for Gleevec, would be $2502 for a 30-day supply; at Cost Plus, a 30-day supply is only $17.10. Cost Plus does not yet offer insulin or ophthalmic drops, but it does offer 100 commonly used vital medicines from antihypertensives to SSRIs to antibiotics with at least 90% savings on many of them.

Currently, 10% of all Americans have had to skip medication doses due to cost. That figure increases significantly among lower income brackets and the elderly. We all know that being priced out of access to medications causes decreased compliance, poorer outcomes/quality of life and increased morbidity/ mortality among our patients. Cost Plus Drugs could be a lifesaver and a gamechanger for patients who cannot afford their medications, people on fixed incomes, and everyone else.

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Patients sign up online at www. costplusdrugs.com, and contact their physician. As the physician, you can e-prescribe or phone or fax in your patient’s prescriptions, ideally using Cost Plus’s downloadable prescription form. The website provides you with all relevant numbers, and the process is simple for both physician and patient. My first thought was that a physician must have helped to create this (with his or her elderly parents acting as quality control testers). Thoughtfully designed, intuitive and simple, the interface and process are both incredibly easy to navigate even for technologically challenged patients (or physicians!).

I encourage you to look at the website and scroll through the list of available medications; you will be pleasantly surprised if not shocked. The provenance of these generics is not given, but they will soon be made on U.S. soil at Cost Plus Drugs’ Dallas manufacturing facility. As with any potentially new and disruptive service, caveat emptor. Elizabeth Holmes and Theranos promised to be the future of laboratory testing and we all saw the debacle of fraud that was eventually exposed. However, this service appears to have a solid business plan and relies on existing technology and suppliers, merely changing the business model to the patient’s advantage.

Cost Plus Drugs isn’t the only game in town—literally. Pittsburgh’s own Blueberry Pharmacy (412-612-2279) is another nationally recognized disruptor of the prescription drug industry, albeit with far less press coverage. Based in West View, Blueberry Pharmacy is a brick-and-mortar independent pharmacy offering a membership model. A membership fee ($60/year or $18/quarter) offers access to similar prices as those offered by Cost Plus Drugs for generic drugs. In addition, patients can receive assistance in finding deep discounts and coupons for brand name drugs. Visit www.blueberrypharmacy.com for details.

This editorial does not constitute an endorsement by either me or ACMS for either Cost Plus Drugs or Blueberry Pharmacy, but encourages you to explore these two resources and determine your own considered opinion. My only conclusion is this: good things come from Pittsburgh.

The opinion expressed in this column is that of the writer and does not necessarily reflect the opinion of the Editorial Board, the Bulletin, or the Allegheny County Medical Society.

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