A heated debate over the U.S. healthcare system erupted on X, pitting billionaire entrepreneur Mark Cuban against Sen. Elizabeth Warren (D-Mass) over the root causes of soaring drug prices.

What Happened: The clash, unfolding as of Friday, has reignited discussions on Pharmacy Benefit Managers (PBMs) and Big Pharma's tax practices, with the Senate poised to address reform amid rising public scrutiny.

Enter Cuban, the Dallas Mavericks owner and founder of Cost Plus Drugs, who fired back with a pointed correction.

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In a post quoting Warren, Cuban argued that PBMs—not Big Pharma—are the true culprits behind inflated drug prices.

“PBMs corrupt healthcare,” he wrote, explaining that these intermediaries control formularies and manipulate prices to maximize rebate revenue, with three major PBMs negotiating over 90% of rebates for commercial insurance plans.

Warren, in her post, had blamed pharmaceutical giants like Johnson & Johnson JNJ and Pfizer Inc. PFE for charging Americans the “highest drug prices in the world” while paying “zero dollars in federal taxes.”

Citing data from her Senate Finance Committee role, Warren highlighted how these companies, alongside AbbVie Inc. ABBV, Amgen Inc. AMGN, and Merck & Co Inc. MRK, have exploited tax loopholes from the 2017 Tax Cuts and Jobs Act to shield billions in profits.

“Republicans want to make it worse. I’m fighting back,” she declared, sharing a CNBC headline and urging action against what she calls a “rigged tax system.”

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Why It Matters: Cuban has been a critic of the healthcare system, saying that it should be simple. According to him, it’s become overly complicated by big insurance companies and PBMs.

These groups, he says, act as middlemen, controlling not just the costs but also the accessibility of care.

He blames PBMs for lack of transparency, inflated specialty drug prices, rebate distortion, formulary restrictions, and “Sh–ing on” on independent pharmacies.

Some significant firms engaged in the PBM business listed in the U.S. include;

StocksYTD PerformanceOne Year Performance
CVS Health Corp. CVS51.15%9.57%
Cigna Group. CI14.54%-6.95%
UnitedHealth Group Inc. UNH-39.11%-36.60%

Meanwhile, here is how some pharmaceutical sector ETFs have performed;

Pharma ETFsYTD PerformanceOne Year Performance
VanEck Pharmaceutical ETF PPH1.69%-4.48%
iShares US Pharmaceuticals ETF IHE-0.49%-1.85%
Invesco Pharmaceuticals ETF PJP-3.23%-1.64%
SPDR S&P Pharmaceuticals ETF XPH-4.06%2.61%
KraneShares MSCI All China Health Care Index ETF KURE20.55%22.94%
First Trust Nasdaq Pharmaceuticals ETF FTXH-5.44%-6.27%
Direxion Daily Pharmaceutical & Medical PILL-23.49%-14.63%

The SPDR S&P 500 ETF Trust SPY and Invesco QQQ Trust ETF QQQ, which track the S&P 500 index and Nasdaq 100 index, respectively, were mixed in premarket on Friday. The SPY was down 0.30% at $595.67, while the QQQ was 0.015% higher at $529.07, according to Benzinga Pro data.

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