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Mark Cuban, co-founder of Mark Cuban Cost Plus Drugs, has a simple message about prescription prices.
“If someone’s insurance says a prescription costs $500 but they can buy the exact same drug for $100 at CostPlusDrugs.com, they should know that before they leave the doctor’s office,” he said in an Oct. 15 announcement from Epic. (1)
He was talking about Prescription Marketplace, a tool from health records company Epic that will show doctors and patients a pharmacy’s cash price next to what the patient would pay through insurance.
Epic says it will release the tool in summer 2027. (1) Amazon Pharmacy, Costco, Eli Lilly and Cuban’s own Cost Plus Drugs are among the companies involved. (2)
I’ve been a CPA since 1981, and Cuban is right: you should know the cash price. But if you’re on Medicare, there’s a catch that’s easy to miss.
Medicare’s own 2027 guide says that when you use discount cards instead of your Medicare coverage, the purchase doesn’t count toward your Medicare deductible or out-of-pocket maximum. (3) And that maximum is real money: $2,100 this year and $2,400 in 2027. (4)
Open enrollment runs Oct. 15 through Dec. 7. (3) Here are 5 things to know before you start buying drugs outside your plan.
1. You don’t have to wait until 2027 to ask
Epic’s tool isn’t out yet, but nothing stops you from doing the comparison yourself today. Ask the pharmacist what your plan charges and what the cash price is. Then check a couple of cash-price pharmacies before you fill.
Even Medicare is nudging you this way. Its 2027 guide tells people with Medicare to compare their plan’s drug prices with prices on TrumpRx.gov, a free site that connects you with special offers and the lowest cash prices for certain drugs. (3)
You can’t buy drugs there, but you can use its coupons at your pharmacy. (3)
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2. Discount-card purchases don’t count toward your Medicare limits
This is the catch. According to Medicare, when you use TrumpRx and other types of discount cards instead of Medicare or other coverage, it isn’t considered creditable coverage and doesn’t count toward your deductible or out-of-pocket maximum. (3)
Why does that matter? Because what you pay out of pocket for covered drugs through your plan moves you closer to the point where you owe nothing for covered drugs the rest of the year. Medicare says money spent with TrumpRx and other discount cards doesn’t.
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3. Know your two numbers: the deductible and the cap
No Medicare drug plan can have a deductible above $615 in 2026 or $700 in 2027, and some plans have none. (4)
Once your out-of-pocket spending on covered Part D drugs reaches $2,100 this year, or $2,400 in 2027, you owe nothing for covered drugs the rest of the year. (4)
Write your own plan’s numbers down. You can’t make a smart cash-or-plan decision without them.
4. When cash is likely to win, and when it isn’t
Here’s my read as a CPA. Buying outside your plan tends to make sense for a cheap generic when you’re nowhere near your cap. Say your plan charges a $25 copay for a monthly generic you could buy for $8 in cash.
That’s a hypothetical $204 a year in your pocket, and on their own, $300 a year in copays wouldn’t come close to the $2,100 cap.
It tends to backfire with expensive brand-name drugs. If your prescriptions are likely to push you to the $2,100 or $2,400 cap, paying with a discount card outside the plan can delay the day you stop paying for covered drugs.
When in doubt, run both numbers for the full year, not just one fill.
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5. Use open enrollment to fix the real problem
If you’re buying a lot of your drugs outside your plan, it may simply be a poor fit. Medicare says it’s important to review changes to your costs and coverage and decide whether to make changes during open enrollment, Oct. 15 through Dec. 7. (3)
Two more things to know. Negotiated prices for 15 more Part D drugs take effect Jan. 1, 2027, so check whether yours is on the list. (3)
The Medicare Prescription Payment Plan can spread your drug costs across the year, but Medicare notes it doesn’t save you money. (4) And ask whether you qualify for Extra Help, a Medicare program that helps pay drug costs. (4)
My honest take
Cuban’s push for price transparency is good for everybody, and it’s about time. If an insurance price is five times the cash price, as in Cuban’s example, that shouldn’t be a secret.
But on Medicare, the cheapest price at the counter isn’t always the cheapest year. Know your deductible, know your cap, and do the math before you buy outside your plan. The goal isn’t to win one trip to the pharmacy. It’s to keep the most money by Dec. 31.
Sources: 1. Epic; 2. Fierce Healthcare; 3. Medicare.gov; 4. Medicare.gov
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