Cost-Plus Pharmacy

A cost-plus pharmacy sells a drug for what it paid for the drug, plus a fixed markup, plus a stated fee, and shows you the math. The best-known example is Mark Cuban Cost Plus Drugs, which opened in 2022 and prices every drug at its acquisition cost plus 15 percent, plus a pharmacy fee of about $5 and shipping. A 30-day supply of generic imatinib, a leukemia drug that lists near $9,000, sells there for around $40. Blood pressure, cholesterol, and diabetes generics often come in under $10.

The model works because most generics really do cost pennies, and the usual retail price has little to do with that cost. It has limits. Cost-plus pharmacies mostly carry generics and a growing but still short list of brand drugs, they usually run by mail with a few days' wait, and in many cases the purchase is made outside your insurance, so it may not count toward your deductible unless your state has a law requiring it (Texas does for state-regulated plans) or your plan agrees to accept the receipt. Some plans and PBMs now contract with cost-plus pharmacies directly so the claim runs through insurance at the transparent price. For an employer, that is the version worth asking for.

The takeaway: if you take a maintenance generic, price it at a cost-plus pharmacy once. If the number is a fraction of your copay, you have learned what the drug costs, and you can decide whether the deductible credit is worth the difference.