Mark Cuban on High Drug Prices, Taxing Billionaires, and 2028

What It Covers

Mark Cuban joins Kara Swisher on Pivot to break down why U.S. prescription drug prices remain artificially high, how PBMs manipulate formularies to block competitors like Cost Plus Drugs, why California's proposed billionaire tax is structurally flawed, and what chips-as-an-asset-class means for crypto-adjacent investors watching the next speculative narrative form.

Key Questions Answered

• •PBM Formulary Control: Pharmacy Benefit Managers threaten brand-name drug manufacturers with formulary removal — potentially costing them hundreds of millions across their entire drug portfolio — if those manufacturers sell through Cost Plus Drugs. This single leverage mechanism blocks transparent pricing from reaching patients. Eliminating PBMs' ability to control formularies would immediately destabilize their pricing power and force market-rate competition across the entire prescription drug supply chain.
• •AI Contract Auditing for Health Care Savings: Any self-insured company covering 1,000-plus employees can run their full PBM and health insurance contracts through Claude or ChatGPT with the prompt asking where pricing definitions are mismatched or fees are hidden. Cuban reports one company discovered millions in overcharges and received a refund after an audit. Self-insured employers cover 67% of workers with employer-sponsored insurance, making this the highest-leverage cost-reduction move available to corporate leadership today.
• •Biosimilar Price Collapse: The arrival of biosimilars — injectable drug generics — drove the largest year-over-year prescription drug price drop in over 60 years. Stelara dropped from $128,000 annually to $365 per two-month supply on Cost Plus Drugs. Humira fell from $8,000 monthly to roughly $450. Patients on high-cost injectable biologics should check costplusdrugs.com immediately, as biosimilar availability is expanding and prices continue declining as volume increases.
• •California Billionaire Tax Structural Flaw: The proposed 5% one-time California billionaire tax assumes liquid assets that typically don't exist — a founder owning 10% of a $10 billion private company is legally a billionaire but likely holds near-zero cash. The state's proposed solution — loaning founders money against illiquid shares so they can pay the tax back — creates circular debt with no economic benefit. Cuban argues an alternative minimum tax at the federal level would be structurally sounder and harder to evade through relocation.
• •Chips as the Next Speculative Asset Class: Cuban argues Nvidia and AMD chips function like rentable apartments — highest value when new, depreciating over time, generating revenue while operational. He proposes tokenizing individual chips via crypto infrastructure, selling fractional revenue rights similar to commodity contracts, creating a narrative-driven asset class that appeals to crypto capital seeking the next speculative vehicle. Bitcoin, by contrast, has failed its original thesis as a hedge against fiat instability and geopolitical risk despite ideal macro conditions.
• •Sports Team Valuation Risk Factors: NBA franchise valuations — exemplified by the Lakers' $12.5 billion deal — depend on two compounding assumptions: tech asset prices remaining high enough to borrow against for the required 15% ownership stake, and streaming rights deals continuing to reduce subscriber churn for platforms like Paramount Plus. If either collapses, valuations follow. Cuban bought the Dallas Mavericks for $285 million in 2000; the real value driver was always arena concerts, surrounding real estate development, and league-wide TV revenue splits — not winning championships.