Cost Plus Drugs, the online pharmacy founded by billionaire entrepreneur Mark Cuban, will participate in TrumpRx, the Trump administration’s drug price transparency initiative. Cuban, an outspoken critic of the pharmacy benefit manager (PBM) industry, made the announcement during his keynote address at the HLTH Conference in Las Vegas.
TrumpRx, announced last month, is a website set to launch in 2026 that will allow Americans to shop directly for prescription drugs at discounted rates without insurance. The platform will not sell or distribute medications directly but will serve as a search engine linking consumers to direct-to-consumer drug websites.
A core feature of the program is the “most-favored-nation” (MFN) pricing model, which requires drug manufacturers to match or beat the lowest prices paid in comparable wealthy countries. For consumers, this could mean discounts of up to 80% off list prices for cash-paying patients. Many insured consumers may see limited benefit, however, because their existing plans already negotiate substantial discounts. The initiative is expected to have the greatest impact on uninsured or out-of-network patients.
Cuban said Cost Plus Drugs will provide TrumpRx access to its application programming interface (API), enabling the platform to pull real-time pricing data. Launched in 2022 as a challenge to the PBM structure, Cost Plus Drugs sells a limited selection of medications directly to consumers at cost plus a 15% markup. Cuban notes that sharing prices on TrumpRx will increase visibility, drive higher volumes, and allow further price reductions to benefit consumers.
Cuban has long criticized PBMs for driving higher drug costs through rebate and incentive misalignments, as well as squeezing independent pharmacies through unfair reimbursements and audits. Although Cuban did not endorse Trump during the 2024 election, he acknowledged that the administration deserves credit for engaging on drug cost issues.
The TrumpRx DTC and MFN model could disrupt traditional PBM channels, employer prescription plans, and retail pharmacies. For example, the platform may reduce reliance on PBM formularies and rebates, and shift volume away from physical pharmacies if patients purchase directly from manufacturers. Employers may also face challenges integrating TrumpRx into benefit designs, tracking utilization outside of insurance claims, and adjusting to altered drug pricing benchmarks.
Pfizer was the first major pharmaceutical company to join TrumpRx, offering select drugs such as Eucrisa and Xeljanz at deep discounts, with Medicaid pricing aligned to the MFN benchmark. AstraZeneca followed as the second manufacturer, committing to discounted drug offerings and U.S. investment under the same framework.