Mark Cuban's Pharmacy Adds Another Onc Drug: Capecitabine

Roxanne Nelson, RN, BSN

May 26, 2023

In late April, the Mark Cuban Cost Plus Drug Company added another oncology drug to its formulary: capecitabine.

This addition brings the total number of generic cancer drugs sold through Cuban's online pharmacy to 11.

Capecitabine is used to treat a wide range of malignancies, including breast, colon, rectal, stomach, esophageal, pancreatic cancers. Without a coupon, the average cost of 60 500-mg tablets is $1564.64, or $26.08 per pill, according to WedMDRx.

Many online or local pharmacies provide coupons that significantly lower the price, but the range is significant and varies by location. Using the WebMDRx coupon, for instance, the prices in Westchester, New York, stretch from $0.46 per pill from Capsule to $19.65 per pill from RiteAid, while the prices in Los Angeles go from about $0.66 per pill from Capsule to $29.43 per pill from RiteAid.

Cost Plus, which began operating in January 2022, is selling 60 500-mg tablets of capecitabine for $23.40, or $0.39 per pill — likely the lowest retail price in the US.

In a Twitter post on April 26, radiation oncologist Fumiko Ladd Chino, MD, celebrated the addition of capecitabine to the online pharmacy: "costplusdrugs has #Xeloda #capecitabine for <$25/month for a 500mg BID dose WITHOUT health insurance. This will be a game changer" for those with GI cancers and triple-negative breast cancer.

Rena Conti, PhD, agreed. "I think this announcement about capecitabine is going to have a positive impact on patients," said Conti, associate professor of markets, public policy, and law at Boston University, in Massachusetts. "It's huge, especially for those uninsured or underinsured."

Cuban has been very transparent about drug costs at his online pharmacy. "People can see exactly what they are paying for," Chino, of Memorial Sloan Kettering Cancer Center, New York City, told Medscape Medical News. The pricing on the site lays out the "cost of ingredients and manufacturing plus a 15% margin, $3 pharmacy dispensing fee, and $5 shipping fee."

On the Cost Plus website, Cuban explains why his company includes the 15% markup: "We mark that price up by 15% so we can continue to run the company and invest in disrupting the pricing of as many drugs as we possibly can."

This level of openness is rare in the drug pricing world, which is typically plagued by "a big lack of transparency," said Chino. "Cost Plus is disrupting this whole process."

Drug Shortage Influence?

Shortly after Chino applauded Cost Plus for adding capecitabine to its formulary, Razelle Kurzrock, MD, of the Medical College of Wisconsin, in Milwaukee, provided a note of caution: "I hate to break the excitement, but I'm predicting that at that price, within a year no one will be making the drug and it will become unavailable due to a 'shortage.' "

The US is currently facing the worst drug shortage in a decade, according to data from the American Society of Health-System Pharmacists (ASHP). Generic forms of chemotherapy agents approved to treat a range of cancers are among the top drug classes that are affected.

Capecitabine was added to ASHP's list of drugs in short supply on February 1.

As of May 26, the 150-mg and 500-mg formulations of capecitabine have been available at Cost Plus.

But Cuban's online pharmacy has issued an advisory on its website that some drugs are out of stock: "We are experiencing low inventory on select medications because of national supply chain and shortage issues. We sincerely apologize for this inconvenience."

Among the cancer drugs available at Cost Plus, only anastrozole 150 mg was out of stock as of May 26.

The existing drug shortage is not unique for the US. Drug shortages have been a problem for about two decades in this country, and those shortages have been unrelated to Cuban's entry into the marketplace, Conti explained. "Cuban's entry into this market is not going to cause shortages," Conti said.

The current shortages are part of bigger problems affecting the US healthcare system, Chino explained. A shortage becomes "especially urgent when drugs are out of stock, and it is something that could be curative for a cancer patient," she said.

Cuban is hoping to circumvent some of the shortage problems in the future by not relying on a third party to supply drugs. Cost Plus aims to start manufacturing medications. The company is currently in the process of building a state-of-the-art pharmaceutical facility in Dallas, Texas, where it plans to produce its own high-quality medicines at low prices.

"Mark Cuban is not a philanthropist," said Chino. "He is an entrepreneur and a businessman. In this case, he is building a successful business that will also help people tremendously. It's a win-win situation for everyone."

Roxanne Nelson is a registered nurse and an award-winning medical writer who has written for many major news outlets and is a regular contributor to Medscape.

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