The Mark Cuban Cost Plus Drug Company pharmacy often charges prices for prescription drugs that are lower than employer plan cost-sharing requirements for those drugs, according to a new peer-reviewed research paper.
Dr. John Lin, a researcher at the University of Texas MD Anderson Cancer Center in Houston, and his colleagues found that employer plans usually beat Cost Plus for drugs with a health plan copay of $15 or less.
But Cost Plus beat employer plan cost-sharing amounts at least 77% of the time for drugs with copays or coinsurance amounts over $15.
When Cost Plus was cheaper, the average level of savings was $6 for a prescription in the $15-$24 copay category; $15 for drugs in the $25-$49 category; $45 for drugs in the $50-$99 category; and $115 for drugs in the $100-and-up category.
About 14% of the commercial plan claims included in the analysis had patient cost-sharing amounts over $15 and were available from Cost Plus.
The researchers published the article behind a paywall in Annals of Internal Medicine.
What it means: Cancer researchers think that even workers with good employer plan coverage should consider looking at online direct-to-consumer pharmacies when traditional plan copays are high.
Internal Medicine.
The backdrop: Some have wondered whether direct-to-consumer pharmacies can save workers with typical employer plan coverage much money.
Authors of an earlier study, conducted by neurologists, found that Cost Plus had only 33 of the 79 drugs analyzed and that Cost Plus beat employer plan cost-sharing requirements for only two drugs.
The Lin study: Lin and his colleagues conducted their study by getting copayment and coinsurance amount data for employer plan generic drug claims that flowed into the Merative MarketScan database in 2024.
The researchers then matched the patient payment data with Cost Plus drug cost data for the same drugs.
The researchers excluded drugs with zero cost-sharing requirements under the Affordable Care Act and controlled substances.
The researchers then adjusted the Cost Plus data to 2024 levels.
The researchers then sorted the claims by out-of-pocket cost level and focused on the 50 drugs in each disease category wth the most claims with cost-sharing amounts over $100.
The researchers found that 97% of the 62 million Merative Marketscan claims that met their conditions were for drugs available through Cost Plus.