Consumers and employers are struggling to keep pace with rising prescription drug costs, and large pharmacy benefit managers are facing increased scrutiny.
A new analysis says the independent pharmacy Cost Plus Drugs charges buyers an average of 67% less for medications than typical corporate-owned pharmacy managers. The analysis by 3 Axis Advisors, a paid consultant for Cost Plus, examined prescription drug costs paid by employers, which provide health benefits for most working-age Americans.
The report suggests Cost Plus could save employers about $47.50 per prescription compared with pharmacy benefit managers, or PBMs. It does not directly measure what consumers pay at the pharmacy counter, but employer costs are shared by consumers, who typically pay part of the bill through copayments and deductibles.
The analysis comes as Congress and employers scrutinize PBMs and prescription drug spending. PBMs negotiate drug prices for employers and consumers. Most employers use one of three large PBM companies: CVS Caremark, Express Scripts and Optum RX.
A recent survey found the share of employers contracting with the three largest PBMs fell from 63% in 2025 to 54% in 2026. More than half of employers still working with those companies are considering changing or dropping their benefit manager within the next one to three years, according to the National Alliance of Healthcare Purchaser Coalitions survey.
Employers are considering changes because they are frustrated by rising costs for hospitals, doctors and pharmacies, experts say.
“Employers are leaving the three big PBMs because they don’t know what they’re paying for,” said Jenny Goins, interim president and CEO of the National Alliance of Healthcare Purchaser Coalitions. “The contracts are written in such a way that you need three or four lawyers to tell you what it says.”
A recent Government Accountability Office report found that health conglomerates that own PBMs and pharmacies usually give their own pharmacies better prices on prescription medications. The study suggests patients and taxpayers might not be getting a fair deal, according to U.S. Rep. Lloyd Doggett, a Texas Democrat.
“There is a real danger that consumers and taxpayers are being ripped off by giant health conglomerates,” Doggett said.
Employers Seek More Transparent Drug Pricing
Goins said more employers are turning to smaller PBMs with more transparent pricing models. Some employers are choosing multiple vendors, including Cost Plus Drugs, to manage prescription benefits.
“We are definitely seeing employers be more aggressive in how they try to structure their pharmacy benefits,” said James Gelfand, president and CEO of The ERISA Industry Committee, which represents companies that provide employee benefits. Employers are trying to control costs and keep drugs affordable for workers and families, he said.
Cost Plus Drugs, launched by entrepreneur Mark Cuban, says it sells prescriptions at the price it pays the manufacturer, plus a 15% markup to cover operating costs. The company does not use common PBM tactics such as rebates or spread pricing — charging an employer or insurer more for a drug than it reimburses a corporate-owned pharmacy for dispensing it.
The 3 Axis report sampled employers that paid more than $433 million in prescription drug insurance claims in 2024 for workers and their families. The report said Cost Plus could have filled more than 70% of those prescriptions, which were mainly lower-cost generic drugs and biosimilar medications.
Where the Savings Could Fall Short
Cost Plus does not typically carry many of the pricier specialty drugs that can drive employer costs higher. For the medications it does carry, its prices would deliver average savings of 67% compared with PBMs, the report said.
The report says employers could potentially save by using multiple vendors — for example, buying generic drugs from Cost Plus while relying on a PBM for specialty medications, according to Gelfand.
3 Axis Advisors noted that its report does not account for rebates PBMs might share with employers on brand-name drugs. PBMs often seek rebates from drug manufacturers, and employers may receive some or all of those savings, the report said. Cuban said most of the drugs in the analysis are generics, which do not have rebates.
“We charge the same price to everyone,” Cuban told USA TODAY. “Few others, if any, do this. Because the big PBMs try to maximize profits, they will price as high as a contract will let them.”
A spokesman for the Pharmaceutical Care Management Association, which represents PBMs, said the 3 Axis analysis falls short.
“Mark Cuban’s company offers only a fraction of the drugs that patients need from a real drug benefit, and this report, like most of Mark Cuban’s claims, relies on cherry-picked drugs that categorically misrepresent the value PBMs provide 289 million Americans,” said Brendan Buck, the association’s chief communications officer.
Goins said many employers are frustrated by the lack of price transparency at large PBMs, prompting some to switch to smaller companies. Many employers also do not get full access to claims data, so they lack details about the medical and prescription bills they pay, said Antonio Ciaccia, president of 3 Axis Advisors and a co-author of the report.
“You’re asking them to navigate a marketplace with a blindfold on,” Ciaccia said.
A law passed by Congress earlier this year would require PBMs to disclose more details to employers that fund their own insurance plans. The Department of Labor drafted a rule that would require PBMs to disclose more information about payments, rebates and pricing.
Can Consumers Save by Shopping Directly?
A study published in the Annals of Internal Medicine suggests consumers with employer-sponsored insurance might save money by shopping directly from Cost Plus or other direct-to-consumer pharmacies. People with copays of $15 or more could save nearly 80% of the time, the study found. Savings could be greater for people who pay $100 or more for higher-priced generics used to treat cancer, digestive issues, psychiatric conditions and heart conditions.
The study examined people with employer-sponsored health insurance, not those covered by Medicare or Medicaid. It also did not compare potential savings with other consumer websites, such as GoodRx.
Cuban told USA TODAY he expects more companies to scrutinize prescription and health care spending as costs rise. “Companies can’t afford the cost of health care any longer,” he said. “Every penny they save goes right to the bottom line.”
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