High prescription drug prices adversely affect payers, providers, and patients. Patients experiencing high out-of-pocket costs for prescription drugs suffer from financial toxicity, leading to a negative impact on their quality of life and potentially on the effectiveness of their treatment regimens. For example, financial toxicity manifests in various ways, including reducing spending on food, clothing, or leisure activities; increasing feelings of anxiety or depression; and skipping drug doses or not filling prescriptions.¹

Financial toxicity due to expensive prescription drug regimens is a growing concern among patients and providers, but how bad is it? According to the Kaiser Family Foundation in 2020, 9% of adults on average reported either delaying or not receiving care due to cost reasons compared with 13% for patients who identified as Hispanic and 10% for patients who identified as Non-Hispanic Black.² Furthermore, those patients who decided to delay or forgo care altogether reported to be uninsured at a rate five times compared with their insured counterparts.² Lastly, of the adult patients who reported either delaying or forgoing care, 11% of patients identified prescription drugs as the main type of care that was impacted.²

Within urology, our field must remain committed to identifying and overcoming barriers that our patients face, especially when generating solutions to financial toxicity that affects our patients’ quality of life. For example, one national, retrospective, cross-sectional study of patients treated for prostate cancer identified several factors that contributed to subjective financial burden—an aspect of financial toxicity—including younger age, low income, and presence of a caregiver.³ Given how many factors could potentially contribute to patients experiencing financial toxicity, a multi-pronged mitigation strategy is necessary, with the first and best step being facilitating clear, consistent, and compassionate conversation about our patients’ experiences in the first place.^4,5

Other best practices for urologists include the use of patient-centered resources and decision aids, measuring financial toxicity using such patient-reported outcome measures as the Comprehensive Score for financial Toxicity (COST), and integrating financial counseling in our practices as part of a multidisciplinary and comprehensive care team.^4,5 In an ever-changing landscape where providers are taking on increasingly more responsibility as stewards of high-value medical and surgical care, having reliable avenues to reduce financial toxicity and enhance patient outcomes is crucial. Ensuring our patients have access to affordable urologic prescription drugs is essential to securing low-cost, high-quality access and decreasing health care disparities for our patients well into the future.

One tangible path to reducing financial toxicity from prescription drugs in a reliable manner is utilizing the Mark Cuban Cost Plus Drugs Company (MCCPDC) that was founded in January 2022 by Mark Cuban and Alexander Oshmyansky. MCCPDC offers a reliable model for consistent cost savings for payers, providers, and especially patients.⁶ Acting currently as a pharmacy benefit manager, MCCPDC sells their formulary of prescription drugs at a cost-plus pricing scheme that consists of the cost of production, 15% markup, a pharmacy fee of $3 per prescription, and up to $5 of direct-to-consumer shipping.⁶ MCCPDC partners with Truepill, which provides a nationwide network of accredited pharmacists to fulfill prescriptions.⁶ Recent studies by Lalani et al and Cortese et al have shown that the cost-plus pricing scheme can potentially help Medicare Part D, and its beneficiaries realize significant cost savings for the system and within urology, respectively.^7,8 As seen in Figure from Cortese et al, Medicare Part D could have potentially realized cost savings of $1.29 billion for nine of the most common urological drugs, with approximately $656 million coming from abiraterone alone in 2020.⁸

Figure. Projected 2020 cost of 90-day prescription filling compared with 2020 Medicare costs for 9 common urology drugs. MCCPDC indicates Mark Cuban Cost Plus Drugs Company.

With the introduction of MCCPDC into the pharmaceutical market, this new entrant remains committed to a cost-plus pricing structure in a patient-centered manner. We speculate that the combination of transparent pricing, decreased costs for thousands of prescription drugs, and direct-to-consumer shipping will have a positive impact on reducing financial toxicity, increasing access to care, and reducing disparities imposed by socioeconomic barriers. We encourage providers and patients to explore Mark Cuban Cost Plus Drug Company as a potential source for prescription drugs and take another step toward reducing financial toxicity associated with urological drugs. Certainly, additional research into quantifying the impact of MCCPDC on financial toxicity using such standardized patient-reported outcome measures as COST is needed, but we remain encouraged about the positive impact that this public benefit corporation can have on enhancing access to care and reducing health inequities.