How Hylant's PBM Strategy Is Ahead of Mark Cuban's PBM Challenge

In recent years, pharmacy benefit managers (PBMs) have come under scrutiny, particularly from business leaders and entrepreneurs like Mark Cuban, who have raised concerns about transparency in the industry. Cuban has been vocal about the alleged role traditional PBMs play in drug prices, sparking discussions across various media platforms. While Cuban's efforts aim to disrupt the status quo, Hylant has proactively addressed these issues with an innovative PBM strategy that has been in place for several years.

What Is a Pharmacy Benefit Manager?

A pharmacy benefit manager (PBM) acts as an intermediary between pharmacies, drug manufacturers and insurance providers. The following is a partial list of the services they provide:

• Managing prescription drug benefits on behalf of health insurers and self-insured plan sponsors
• Negotiating discounts on drug prices
• Building retail and mail order networks
• Determining how drugs are covered based on their placement on the formulary
• Providing clinical programs that assure the patient has good outcomes with their prescriptions
• Proving prior authorizations to assure that drugs are being prescribed according to the FDA approved use

PBMs were originally designed to reduce drug costs and provide specialized services for employers and plan members. Recently, criticisms have focused on their lack of transparency as a potential cause of high drug costs.

Mark Cuban’s Call for Transparency in PBM Practices

Mark Cuban has turned his attention to the healthcare sector, criticizing the big three PBMs—Caremark, Express Scripts and Optum Rx—for their opaque pricing structures. In a media appearance, Cuban said, “Prior to us, there was no transparency whatsoever, and so nobody knew what the price of any medication was.” His main argument is that traditional PBMs fail to offer employers or employees clear visibility into how drug prices are determined.

While Cuban's push for transparency is gaining media attention, Hylant has proactively addressed these issues since 2019. Through its Preferred PBM Agreement Methodology, Hylant has long embraced transparency as the cornerstone of our approach to pharmacy benefits.

Taking a Transparent Approach to Pharmacy Benefits

Hylant’s innovative strategy predates much of the current discourse around PBMs. By partnering with pass-through PBMs as an alternative to the big three that show clients all claims, data and pricing, we’ve offered businesses a complete view of their pharmacy costs. Unlike traditional PBMs, our strategy removes hidden fees, passing the actual drug costs, rebates, and fees directly to clients, just as they are paid to the pharmacy.

This transparency is validated by independent oversight from PharmD professionals, who work with clients from start to finish. By focusing on transparent contracts with client- focused provisions and ongoing monitoring, we ensure that PBMs adhere to contract terms while providing continuous oversight for prescription drug management. This approach has proven highly effective, helping our clients save significantly on prescription drug costs.

Since inception, our Preferred Pharmacy Programs helped clients realize in excess of $100 million in annual recurring savings, without significant disruptions for plan members. This is a testament to the effectiveness of our unique PBM strategy, which blends transparency with independent pharmacy consulting to deliver measurable results.

The Impact of Cost Plus Drug Company and Industry Disruption

Mark Cuban's Cost Plus Drug Company has also been a topic of interest. The company works directly with drug manufacturers to offer generic medications at lower prices by bypassing traditional PBMs. However, while Cost Plus is creating waves, it is not always the lowest cost solution because the 15% fee added by Cost Plus, along with shipping charges, often narrows the pricing gap between traditional PBMs and the program's offerings.

Additionally, Cost Plus does not provide the same level of clinical support and management services that many employers rely on for medication safety and appropriateness. It doesn’t include prior authorization processes, clinical oversight for drug interactions or side effects or essential programs such as narcotics abuse management. Given the complexity of prescription benefits, lower prices aren’t always the sole factor for employers managing employee health plans.

The distinct advantage that Mark Cuban’s Cost Plus Drug offers is full transparency – 100% of the time. There is room for improvement in the industry with regard to pricing disclosure and we are grateful for industry pioneers that create a new awareness partial solution to the issue.

Hylant’s Ongoing Commitment to Pharmacy Benefit Transparency

Hylant remains committed to delivering a comprehensive, transparent and client-aligned approach to managing prescription drug costs. Our strategy addresses the pricing concerns raised by leaders like Mark Cuban and provides ongoing contract monitoring and independent oversight to ensure the best possible outcomes for our clients and their members.

With the rising cost of medications, employers can no longer assume their existing PBM contracts are optimized. Our independent pharmacy consultants offer an invaluable service, reviewing contracts, identifying potential savings, and making actionable recommendations to reduce costs—all with minimal disruption to plan members.

Take Control of Your Pharmacy Benefits

Transparency and cost containment are crucial in today’s healthcare system. We’re here to help simplify the process, optimize your pharmacy benefits and ensure your employees receive the care they need with transparency.

Ready to explore how we can help your organization? Connect with a Hylant employee benefits advisor and discover how we can bring clarity and savings to your benefits plan.

Related Viewing: Watch our on-demand webinars to gain timely insights and consider strategies for addressing employee benefits-related trends, compliance issues and cost-containment challenges.

The above information does not constitute advice. Always contact your employee benefits broker or trusted advisor for insurance-related questions.