Mark Cuban has never been one to pick small fights. But his latest target — the opaque, convoluted machinery of American health care billing — may be the most ambitious battle he’s waged since disrupting the pharmaceutical industry with Cost Plus Drugs. And this time, the stakes are considerably higher.
Cuban, the billionaire entrepreneur and former owner of the Dallas Mavericks, has been methodically building a case that the U.S. health care system’s billing infrastructure isn’t just inefficient. It’s predatory. In recent public statements and social media posts, he’s argued that the lack of price transparency in medical billing is the single greatest obstacle to affordable care in America — and that fixing it doesn’t require new technology or even new legislation. It requires enforcement of rules already on the books.
The core of Cuban’s argument is deceptively simple. Hospitals and insurers have long operated under a system where the true cost of procedures, medications, and services is buried beneath layers of negotiated rates, chargemaster prices, and opaque contracts. Patients rarely know what they’ll owe until weeks or months after receiving care. Cuban contends this isn’t an accident. It’s a business model.
As Yahoo Finance reported, Cuban has been vocal about the need for radical transparency in health care pricing, drawing on his experience with Mark Cuban Cost Plus Drugs — the online pharmacy he founded in 2022 that sells generic medications at cost plus a flat 15% markup and a pharmacist fee. The pharmacy’s model stripped away the middlemen, particularly pharmacy benefit managers, and exposed just how inflated drug prices had become under the existing system.
Now he wants to do something analogous for the broader health care billing apparatus.
The timing isn’t coincidental. The federal Hospital Price Transparency Rule, which took effect in January 2021, requires hospitals to publish their negotiated rates with insurers in machine-readable files. Compliance has been spotty at best. A February 2025 report from Patient Rights Advocate, a nonprofit that tracks hospital compliance, found that only 34.5% of hospitals were fully compliant with the rule as of their latest review. That’s an improvement from earlier years, but it still means roughly two-thirds of American hospitals aren’t fully disclosing their prices as required by federal law.
Cuban has pointed to this enforcement gap repeatedly. On X (formerly Twitter), he’s called out specific hospital systems for noncompliance, argued that the Centers for Medicare & Medicaid Services should impose steeper penalties, and suggested that entrepreneurs could build tools to make the available pricing data useful to consumers. The maximum fine for noncompliance was raised to $5,500 per day in 2022 — a figure that, for a large hospital system generating billions in annual revenue, amounts to little more than a rounding error.
This is the crux of the problem. The rules exist. The penalties don’t bite.
Cuban’s frustration mirrors a growing consensus among health policy researchers that price transparency alone won’t fix the system unless it’s paired with meaningful consequences for noncompliance and tools that help patients actually use the data. A study published in JAMA Health Forum in late 2024 found that even when hospitals do publish their prices, the data is often formatted in ways that are virtually unusable for ordinary consumers — buried in massive spreadsheets with thousands of line items, coded in medical jargon, and lacking the context needed to compare costs across providers.
“The data is there in theory,” said Cynthia Fisher, founder of Patient Rights Advocate, in an interview earlier this year. “But if you can’t find it, can’t read it, and can’t act on it, what good is it?”
Cuban appears to agree. His approach has been twofold: push for better enforcement at the federal level while simultaneously building private-sector tools that can cut through the noise. Cost Plus Drugs has already demonstrated that this model can work in pharmaceuticals. The company reported filling over two million prescriptions in its first full year of operation, and independent analyses have shown savings of 40% to 90% compared to traditional pharmacy prices on many common generics.
But medical billing is a far more complex beast than drug pricing. A single hospital visit can generate dozens of separate charges — from the facility fee to the surgeon’s fee to the anesthesiologist to the lab work to the imaging. Each of these charges may be negotiated separately between the provider and the insurer, and the patient’s out-of-pocket cost depends on a thicket of variables including their specific plan design, deductible status, and whether every provider involved was in-network.
This complexity is, in Cuban’s view, the point. The system’s opacity benefits incumbents — large hospital systems, insurance companies, and the army of intermediaries that profit from the confusion. Simplifying it threatens powerful interests.
He’s not alone in this assessment. The bipartisan push for health care price transparency has gained momentum in Congress over the past two years. The Lower Costs, More Transparency Act, which passed the House in December 2023 with broad bipartisan support, would have strengthened enforcement of existing transparency rules and extended similar requirements to insurers. It stalled in the Senate but is expected to be reintroduced in some form during the current session.
Meanwhile, a handful of states have moved ahead on their own. Colorado’s hospital transparency enforcement program has been cited as a model, with the state actively auditing hospitals and imposing fines for noncompliance. Several other states, including Texas and Indiana, have enacted or proposed their own transparency mandates that go beyond federal requirements.
Cuban has praised these state-level efforts while arguing they’re insufficient without a federal backstop. “You can’t have 50 different transparency regimes,” he posted on X in early 2025. “Patients don’t stop at state lines.”
The pharmaceutical side of Cuban’s health care push continues to expand. Cost Plus Drugs announced earlier this year that it would begin offering a broader range of brand-name medications through negotiated deals directly with manufacturers, bypassing pharmacy benefit managers entirely. The company has also partnered with several employer health plans to provide medications to their covered employees at Cost Plus prices — a model that, if it scales, could put significant pressure on the PBM industry.
That industry is already under scrutiny. The Federal Trade Commission released a damning report on PBM practices in 2024, finding that the three largest PBMs — CVS Caremark, Express Scripts, and OptumRx — control roughly 80% of the market and have used that dominance to inflate drug costs while squeezing independent pharmacies. The FTC’s findings echoed many of the arguments Cuban has been making for years.
So where does this all lead?
The optimistic scenario is that Cuban’s combination of public advocacy, private-sector disruption, and political pressure creates enough momentum to force real change in how health care is priced and billed in America. The transparency rules are already on the books. The data, however imperfect, is starting to flow. And public anger over health care costs remains at a boiling point — a KFF Health Tracking Poll from February 2025 found that 67% of Americans say the cost of health care is their top financial concern, ahead of housing and groceries.
The pessimistic scenario is that the incumbents — hospital systems, insurers, PBMs — have too much money and too many lobbyists for any one entrepreneur, however wealthy and persistent, to overcome. The health care industry spent over $700 million on lobbying in 2024, according to OpenSecrets, making it the largest lobbying sector in Washington by a wide margin.
Cuban seems to understand the odds. But he also seems to relish them. “Everyone told me Cost Plus Drugs wouldn’t work,” he said in a recent podcast appearance. “That the PBMs were too powerful, that the system was too entrenched. We proved them wrong on drugs. We can prove them wrong on the rest of it.”
Whether he can or not, the conversation he’s forcing is overdue. For decades, the American health care billing system has operated on the assumption that patients don’t need to know — and can’t handle knowing — what things actually cost. Cuban’s bet is that once they do know, they’ll demand something better.
That bet, at least, seems like a safe one.
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