Cutting Out the Middleman in American Healthcare: Comparative Insights into PBM-Free Cancer Drug Pricing

Author: Aidan A. Le¹ and Nureldin Mohamed²

Affiliation: ¹University of California, Los Angeles (UCLA), Los Angeles, CA, USA
²Harvard University, Cambridge, MA, USA

Abstract:

Cancer drug affordability remains a pressing global health challenge, often exacerbated by monopolistic control and pharmaceutical supply chains. In the United States, where pharmacy benefit managers (PBMs) negotiate drug prices, final costs remain disproportionately high. Independent entrepreneurs, such as Mark Cuban’s Cost Plus Drug Company, have begun to challenge conventional pricing strategies by bypassing third-party intermediaries altogether. This study evaluates the potential of direct-to-consumer pharmaceutical models for reducing cancer drug costs worldwide. We conducted a comparative cost analysis of commonly prescribed cancer drugs using pricing data from 2013-2022 across the United Kingdom, Australia, and South Africa, countries with minimal PBM influence, and benchmarked these against Medicare Part D prices in the United States. We tracked the average 30-day fill cost for several high-utilization cancer medications over the past decade. Preliminary findings reveal that the United States has substantially higher per-person cancer drug costs compared to the three reference countries. The absence of PBMs is correlated with lower consumer prices, suggesting streamlined supply chains can yield meaningful improvements in affordability and access. Our research underscores the transformative potential of independent pharmaceutical entrepreneurs in disrupting monopolistic structures and mitigating soaring cancer drug costs. Direct-to-consumer models, exemplified by Cost Plus Drug Company, appear poised to improve patient outcomes, reduce financial strain, and advance health justice. Achieving scalability will require proactive policy reforms, greater market transparency, and sustained investment in innovation, reshaping the pharmaceutical landscape for more equitable global access to cancer treatment.

Keywords: Cancer drug affordability, Pharmacy benefit managers (PBMs), Direct-to-consumer pharmaceutical models, Drug pricing disparities, Cost Plus Drug Company

ISSN 3069-8200

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