TrumpRx, Mark Cuban, and Why the Pharmacy Conversation Is Suddenly About You

First, the White House launched TrumpRx.gov in February and just expanded it in May to cover more than 600 generic medications. It’s a price-comparison site – a federal version of GoodRx, essentially – that shows cash prices on drugs purchased directly from manufacturers or partner pharmacies. Cost Plus Drugs, Amazon Pharmacy, and GoodRx are all integrated into it. Patients can’t buy through TrumpRx itself; they get directed to whichever partner has the best cash price.

Anyone who has spent as much time as I have trying to contain medical spend knows that drug costs are arguably the largest contributor to overall healthcare costs. The idea of lowering these costs is a noble one. However, nearly every administration has attempted to tackle this issue, and over the last several decades, Big Pharma has consistently prevailed.

Second, in late April, Mark Cuban’s Cost Plus Drugs announced a partnership with Humana’s CenterWell Pharmacy aimed squarely at employers. CenterWell adopts Cost Plus’s SwiftyRx software, and together they’re building “end-to-end employer prescription solutions” – pass-through drug pricing at acquisition cost plus 15%, delivered directly to your employees, without the traditional PBM markup. Cost Plus already claims 50–90% savings on generic spend for the plan sponsors they work with today.

So why does any of this matter to a Mid-Market Employer? Three reasons.

Your employees are already using these options, with or without you. If you’re in a high-deductible plan, the math on a $23 generic from Cost Plus versus a $200 in-deductible run through the carrier is obvious. The catch: cash purchases outside your plan do not count toward deductibles or out-of-pocket maximums. That’s a real trade-off, and most employees don’t realize it until they hit a hospitalization and find out the $1,200 they saved on prescriptions all year didn’t move them an inch closer to their deductible maximum.

Cost Plus has been quietly signing up employer clients for two years. Now they have a Fortune 50 distribution partner. TrumpRx, whatever you think of it politically, brings federal attention to direct-to-consumer pricing. The Federal Trade Commission’s recent Express Scripts settlement requires Express Scripts to “provide covered access to TrumpRx as part of its standard offering.” That’s a regulatory wedge, not just a website.

This is the part most relevant to you – there’s a real new option on the table for self-funded employers. Cost Plus offers two ways in: you can add them to your existing PBM’s network as a preferred pharmacy, or you can bolt them on as a standalone pharmacy benefit alongside your medical plan. Neither requires you to replace your current carrier relationship.

TrumpRx itself is a coupon book, useful at the margins. The bigger story is that the broader market – Cost Plus, CenterWell, the FTC, even Amazon Pharmacy – is moving toward transparent, pass-through pharmacy pricing. That’s a tailwind employers should be positioned to catch.

Pull your last twelve months of pharmacy claims. (The details and availability will depend on your company size and whether you are self-funded or fully insured.) Identify your top 20 drugs by spend. Price those same drugs at Cost Plus and on TrumpRx.gov, and see where the gaps are. If the delta is meaningful, we should have a conversation about whether a Cost Plus bolt-on, a transparent PBM, or a deeper plan-design change is the right next move.

I don’t think anyone should change a benefits program because of a website. But I also don’t think anyone should keep paying 2018 prices for 2026 pharmacy because the PBM contract auto-renewed in November. Worth a look.