Battling Big Pharma: A Conversation with Mark Cuban | The Big Interview | WIRED

Cost Plus Drugs and Healthcare Transparency

• Mark Cuban is the co-founder of Cost Plus Drugs, a company working to make the prescription drug industry more transparent by showing the actual cost of medications and marking them up by only 15%. (10s)
• Cuban got into the pharmaceutical business after receiving a cold email from Dr. Alex Oshmayansky, who wanted to start a compounding pharmacy, and was inspired by the lack of transparency in the industry, particularly after Martin Shkreli's case. (1m45s)
• The idea for Cost Plus Drugs was born out of the realization that the pharmaceutical industry was opaque, with no transparency, and that patients often had to deal with the fear of not being able to afford their medications. (2m13s)
• Cost Plus Drugs aims to make the process of buying prescription drugs more transparent by showing the actual cost of the medication, a 15% markup, a $5 pharmacist fee, and a $5 shipping fee, or the option to pick it up at a local pharmacy. (3m1s)
• By showing their prices and costs, Cost Plus Drugs has been able to significantly reduce the price of certain drugs, such as imatinib, chemotherapy drugs, and MS drugs, from over $2,000 per month to as low as $21 or $35 per month. (3m23s)
• Imatinib is a notable example of a medication, but the names of medications can be difficult to remember, and people with conditions like multiple sclerosis (MS) often rely on specific drugs, such as droxidopa, which can be expensive without proper insurance coverage (3m45s).
• A friend who needed droxidopa after a car accident was initially told it would cost $10,000 every three months, but it was later discovered that the actual cost was $64 per month, and the price has since decreased to around $20 due to increased volumes and a straight markup pricing model (4m1s).
• Publishing the entire price list for over 2,500 drugs has been a game-changer, allowing researchers to compare prices and identify potential savings, such as a study that found Medicare could save $3.6 billion per year by purchasing nine specific drugs from Cost Plus Drugs (4m45s).
• The lack of transparency in the pharmaceutical industry, particularly among pharmacy benefit managers (PBMs), contributes to the problem, with three major PBMs controlling around 80% of the market and often not disclosing the true costs of medications to self-insured companies (6m2s).
• Self-insured companies working with major PBMs are likely being overcharged, and changing their healthcare program and PBM can result in immediate cost savings, but many CEOs are not aware of this issue due to its complexity and the fact that it is not their core competency (6m16s).
• The Employee Retirement Income Security Act (ERISA) requires self-insured employers to take on fiduciary responsibility for the cost and care of their employees, and companies like J&J and Wells Fargo have been sued for allegedly failing to meet this responsibility (7m22s).
• Companies that do not provide transparent pricing for medications will likely face class-action lawsuits, and individuals with high deductibles or no insurance should always check prices to avoid being overcharged (7m43s).

Business Strategy and Competition

• The goal of creating a transparent and cost-effective medication pricing system is not driven by altruism, but rather by the desire to run a profitable business as a public benefit corporation (8m7s).
• The decision to target the healthcare industry was made because it was an obvious area for change, with a history of incumbents buying out potential threats and stifling innovation (9m7s).
• The company has been in business for two and a half years, shipping medications and changing the lives of millions of people, but has encountered situations where potential partners were bought out by larger companies (9m17s).
• The imposition of tariffs by President-elect Donald Trump could potentially affect the pharmaceutical industry, but the company is prepared to adapt and pass on any increased costs to consumers (9m57s).
• The company has already taken steps to mitigate the impact of potential tariffs, such as switching manufacturers for 16 drugs previously sourced from China (10m18s).
• If tariffs are imposed on India, the company would have to pass on the increased costs, which would be around 15% (10m32s).
• The company has not had direct communication with Donald Trump about the potential impact of tariffs, but if given the opportunity, the priority would be to emphasize the importance of not disrupting the current system (10m42s).

Politics and Cryptocurrency

• Mark Cuban does not think a certain individual would make an exception to a policy that would make a product unaffordable for more people, despite initial concerns (11m27s).
• Mark Cuban was a vocal supporter of Kamala Harris for president and does not think he would have done anything differently in terms of communicating her message to business people and small business owners (11m34s).
• Mark Cuban is in favor of cryptocurrency and does not think it should be villainized, believing that the SEC's actions under Gary Gensler hurt Kamala Harris's presidential campaign (12m18s).
• A significant number of young men own or have owned cryptocurrency, with 40% of young men owning or having owned crypto according to Pew research, and Mark Cuban believes Gary Gensler's actions against crypto hurt Kamala Harris's chances with this demographic (13m7s).
• Mark Cuban thinks that Gary Gensler's actions against crypto could have lost the election for Kamala Harris, given the close margin of votes in swing states (13m58s).
• The future of cryptocurrency is uncertain, with a laissez-faire approach being taken, and it will be interesting to see how the market reacts to potential tariffs on countries that stop using the US dollar as a reserve currency (14m18s).
• The value of Bitcoin is partly based on the perceived weakness of fiat currency, and it will be interesting to see how Bitcoin enthusiasts react if the government follows through on its threat to impose tariffs on countries that stop using the US dollar (14m42s).
• Cryptocurrencies like Bitcoin may become more legitimate in a laissez-faire environment, similar to how gold is seen as a safe-haven asset in times of economic uncertainty (15m9s).
• Bitcoin is considered a better version of gold, offering more value due to its ease of buying, selling, fractionalization, and international transferability (15m50s).
• The price of Bitcoin is determined by supply and demand, and owning a significant amount of it would make one want its price to increase (16m10s).

Social Media and Online Engagement

• A self-driving car, such as Waymo, may not be as trustworthy as a seeing eye dog in certain situations, as dogs can recognize adversarial situations better than AI (17m2s).
• Twitter is experiencing an existential moment, with the platform's algorithm controlling the type of engagement users experience, which can lead to negative interactions (18m27s).
• Bluesky, an alternative platform, offers a more controlled experience, allowing users to engage in meaningful discussions without the negative interactions found on Twitter (18m39s).
• The difference in engagement between Twitter and Bluesky is noticeable, with Bluesky allowing for more civil and productive conversations (18m43s).
• The algorithm of a platform plays a significant role in shaping the user experience and the type of engagement that occurs on the platform (18m25s).
• Elon Musk has posted or replied about Mark Cuban over 40 times in the last 12 months, which Cuban finds excessive (18m18s).
• Mark Cuban prefers the experience on Bluesky, where he can engage in discussions about topics like Cost Plus Drugs without the negative interactions found on Twitter (18m46s).
• A feature on the platform Bluesky allows users to hide replies from others, which can be useful in avoiding trolls and maintaining a productive conversation (19m9s).
• Trolls often seek attention, and by hiding their replies, users can render their posts invisible to others, making it pointless for trolls to continue posting (19m22s).
• Even if trolls create burner accounts to circumvent the block, it only takes a few seconds to block them again (19m36s).
• On Bluesky, users have reported a significant reduction in troll posts, with one user citing an instance where only 5 out of 526 responses were from trolls (19m51s).
• Bluesky may be becoming an echo chamber for people who left Twitter due to its toxicity or right-leaning bias, but this doesn't necessarily fix the underlying issues (20m12s).
• However, the platform's features allow users to engage in meaningful conversations and control the discussion by hiding or blocking unwanted posts (20m57s).
• Users can create lists or follow specific feeds to curate their experience and avoid being dominated by a single perspective, such as Elon Musk's tweets (21m8s).
• The platform allows for intellectual engagement and meaningful discussions, with users able to learn from others and engage in respectful conversations (21m22s).
• Despite the presence of some hateful or stupid comments, the overall engagement on Bluesky is positive, with users appreciating the ability to control their experience (21m44s).
• The platform is growing, with over 22 million users, and has attracted notable accounts such as the New York Times, which has referenced Bluesky posts in their articles (22m6s).
• Social networks have become an integral part of culture, allowing users to have conversations and share experiences in real-time, as seen in the ability to discuss a Mavs game on a social network (22m20s).
• The idea that the internet is culture has become more prevalent, and this was evident in the last election, where online reactions and responses played a significant role (22m42s).
• There is a misconception that the left does not have the same kind of audience as the right on social media platforms, but this is not necessarily true (22m54s).
• Twitter remains a significant platform despite its relatively small user base compared to other social networks, due to its outsize influence (23m17s).
• To distinguish reality on social media, it's essential to consider the algorithms that drive the platforms and how they can be influenced by creating engaging content (23m27s).
• Appearing on popular podcasts, such as Theo Von and the Nelk Boys, can help create clips that feed the algorithm on Twitter and increase visibility (23m33s).
• The key to dealing with the algorithm is not to try to create more content that conforms to it, but to "flood the zone" with a wide range of content that dominates the algorithm (24m17s).
• This approach involves creating multiple memes, clips, and other content that caters to different individuals and their customized algorithms on social media platforms (25m16s).
• Mr. Beast's approach to reverse-engineering algorithms on each platform and spending millions of dollars on it is an example of how to effectively flood the zone (24m44s).
• The next political campaign should adopt a similar strategy to engage with voters and create content that resonates with different individuals (24m56s).

Political Strategy and "Flooding the Zone"

• The concept of "flooding the zone" with information is crucial in politics, as it allows a message to spread continuously and be seen by everyone, making it difficult for algorithms to filter out, and this strategy was effectively used by Donald Trump during his campaign (26m2s).
• The idea is that if a message is repeated enough, it becomes a meme and everyone has to respond to it, which is what happened with some of Trump's statements, such as the claim that people were eating cats and dogs (26m15s).
• The strategy of flooding the zone with information was also used by Trump to scare people about certain issues, such as tariffs, taxes, and immigration, and then to provide a solution to those fears (27m5s).
• In contrast, Kamala's campaign started off using a similar strategy but then dropped it and tried to focus on accuracy instead (26m35s).
• The key to success in politics is to be a great salesperson, like Trump, and to be willing to put oneself in crazy situations and flood the zone with information (26m52s).
• The most important thing in politics is who people trust more on the issues that scare them the most (27m2s).

Optimism, Innovation, and the Future of the US

• Despite the current politically volatile and unstable times, there is still hope and optimism for the future, and people should focus on their ideas and passions (27m39s).
• The United States is a country where people can turn their ideas into reality, and this is what makes the country unique (27m54s).
• People in the US are not afraid to take action and pursue their ideas, and this is what drives innovation and progress (28m19s).
• The country's ability to innovate and adapt is what makes it great, and people should be bullish on the United States of America (28m44s).
• The fact that people are still showing up to events and pursuing their passions is a sign of hope and optimism for the future (28m52s).
• The US has a history of embracing new technologies and innovations, with 95% of new technologies being developed or grown in the country over the past 30 years (29m13s).

Conclusion

• The conversation with Mark Cuban has come to an end, and the host expresses a desire to continue the discussion, but unfortunately, there is no more time left (29m37s).
• The host thanks Mark Cuban for being a part of the conversation (29m41s).
• Mark Cuban responds by thanking the host, Laura, for having him (29m42s).
• The audience applauds in appreciation of Mark Cuban's presence and the conversation (29m43s).