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Hi guys, Alex Oshmyansky here, CEO of the Mark Cuban Cost Plus Drug Company. Crazy to see our little project at the top of Hacker News! We're planning to intro

Hi guys, Alex Oshmyansky here, CEO of the Mark Cuban Cost Plus Drug Company. Crazy to see our little project at the top of Hacker News! We're planning to introduce a lot more drugs with transparent prices later this year, cutting out monopolistic middlemen in the supply chain and alleviating pharma drug shortages, particularly for rare and orphan disease conditions. We are looking for a few devs (fullstack, frontend, and backend). If anybody is interested, drop me a line at alex@costplusdrugs.com In the meantime, happy to answer questions if anyone is interested!

evo_9 6y ago
Awesome project! What is the stack, what kind of developers are you looking for? Maybe post a link to your job listings.
- alexosh1 6y ago
  Currently our frontend is react, backend node.js, and a MySQL database with a graphql API (edit). Would be looking for folks to help make a more robust consumer facing site as we add products and different types of customers. We've been focusing mostly on filling roles for the sterile fill-finish facility we are constructing in Dallas (QA, formulation specialists, etc.) and have put building out the dev team for the web sit kind of on the backburner with me just kind of personally managing it at the moment. While Hacker News is looking though... :-)
  - brianwawok 6y ago
    Why do you need a graph database to run a drugstore? You will save hundreds of thousands of dollars in development if you just use postgres...
    - erikpukinskis 6y ago
      GraphQL is not a database it’s just a wire protocol. You need a database behind it and Postgres is quite common. Compare it to JSON:API or GRPC. With Apollo it also solves a lot of frontend caching and state management problems so you can somewhat use it as an alternative to Redux.
    - juancampa 6y ago
      He probably meant a Graphql API in front of the DB (e.g. Hasura)
      - alexosh1 6y ago
        Oops, yeah sorry. Graphql API in front of MySQL
- alexosh1 6y ago
  O should also point out, these roles can be remote
benjismith 6y ago
Hi Alex, I just want you to know, I really admire what you're doing, and I hope you're wildly successful at it!
- alexosh1 6y ago
  Thanks Benjismith!
pyentropy 6y ago
Hey, I wrote about monoamine oxidase inhibitors on Scott Aaronson's blog a few months ago: https://www.scottaaronson.com/blog/?p=4933 https://www.scottaaronson.com/blog/?p=4933 Basically, there's is an international shortage for one of the most effective treatment for severe depression because of an unfortunate series of events, the drug's long history as a generic and the manufacturers' willingness to replace the drug class, and constantly produce new patented molecules with chemical tricks(ex. just taking one isomer in the citalopram->escitalopram case, or even metabolites in the case of venlafaxine -> desvenlafaxine case) like they are 'annual smartphone model releases', except efficacy even goes down. You can read more about it the drug itself on the blog of Scott Alexander (the rationalist/Bayesian psychiatrist guy) as well: https://slatestarcodex.com/2015/04/30/prescriptions-paradoxes-and-perversities/ https://slatestarcodex.com/2015/04/30/prescriptions-paradoxe... And now some years down the line after his observation, the price has exploded, very few new patients get a prescription due to uncertainty and there's no alternative. Your options are either taking taking an atypical antidepressant like vortioxetine or an experimental ketamine.
- peteretep 6y ago
  > monoamine oxidase inhibitors > citalopram ... venlafaxine God I hate myself for being that guy, but neither of the drugs you’ve listed are actually MAOIs. I’m sure the point still stands though.
  - pyentropy 6y ago
    That's exactly the point. The selective classes (SNRI/SSRI) are marketed as a complete and safe replacement for MAOIs, on top of the chemical structure irony. Even the new atypicals with innovative chemical structure (and targets other than 5-HT1/SERT) are of significantly worse efficacy MAOIs I'll edit my parent comment to make it clearer.
    - peteretep 6y ago
      I don’t quite get the point you’re making then, as there’s a lot of generic citralopam on the market, despite escitralopam being patented.
eximius 6y ago
Are there any non-dev, remote roles needed?
loceng 6y ago
Not a question but a request: might not be a massively used drug, however pharmacies where I live don't seem to even carry the generic version of it, but dopamine agonists could use some competition.
stevebmark 6y ago
Will your company become obsolete once the US removes the ridiculous law that US citizens can't buy drugs from other countries? Every modern country has solved the low price drug problem except the US because of criminal and fraudulent healthcare laws.
- alexosh1 6y ago
  Ideally yeah, would be good if we didn't need to exist. There are a variety of policy initiatives the US could likely implement to bring costs down. My kind of mindset with the company though is I am a nobody from nowhere, and congress isn't going to listen to me. I can make cheap / sell medicine at an affordable price though. So I will do that. I'm not sure drug importation will work though, not because it's a bad policy per se, but I'm not sure that other countries will let the US import their low-cost medicines if US law changes in order to protect their domestic supplies. There's Canada as an example case. We have ~10x the population of Canada, and California alone could use up all of Canada's medicines. Not sure Canada would go for it. Think it's worth a shot though. I know there are some trial programs going into place in Colorado and Florida around allowing drug importation. Will be cool to follow and see how they play out.
  - stevebmark 6y ago
    Makes sense, I always appreciate healthcare companies that capitalize on bad laws saying that ideally they wouldn't exist and they're trying to work within the existing framework. Cross-border drug buying works well in the EU, where any European country can buy drugs from any other European country, so whoever has the lowest price usually wins the market. As a private company, your incentive is to maximize profit for shareholders. Since all you have to do is undercut high drug prices a little, what will stop you from the same price gouging that all other US drug companies perform?
    - alexosh1 6y ago
      Well, there's some technical measures we've taken and some practical ones to ensure we work to be profitable but remain focused primarily on improving public health and helping patients. On the technical level, we incorporated as a public benefit corporation, so we are judged not only on how profitable we are for shareholders, but how well be maintain our social mission. That is actually in our charter documents and is a legal requirement. On a practical level, Mark Cuban is our lead investor and his interest is very much focused on helping people and fixing system issues in healthcare. We also did some screening to ensure our other investors are socially minded and prioritize social benefit as well as profits. My mindset is that we need to be profitable to be sustainable and grow enough to help the overall system, but we won't be extortionate.
cliff 6y ago
The website says you're planning to build your own manufacturing plant. What will that plant do? Will you actually be manufacturing your own medication? If so, would that include manufacturing the active pharmaceutical ingredients or will you be sourcing them from generic manufacturers and then making the final drugs at your plant?
- alexosh1 6y ago
  It will be a sterile fill-finish facility. The facility will fill vials of sterile injectable medicine. Those tend to be the drugs which are most affected by shortages and price gouging overall. The facility will just do finished drug products. Our initial drugs are supplied on "private label" arrangements where other companies actually do the manufacturing, and we just add our labels and our own NDC code so we can set the price. Since we don't go through middlemen, that price can often times be a lot lower. We'll have to source API (active pharmaceutical ingredients) elsewhere for now. At some point, would like to completely internalize our supply chain, but one step at a time. :-)
  - voiper1 6y ago
    I know this is crazy, but have you talked with Bill Gates? He planned to pre-fund several coronavirus vaccine manufacturing plans _prior to FDA approval_ just to speed up vaccine production. He expected several of those would end up being wasted money. [1] Perhaps he would find this valuable too? [1] https://www.weforum.org/agenda/2020/04/bill-gates-7-potential-coronavirus-vaccines https://www.weforum.org/agenda/2020/04/bill-gates-7-potentia...
executive 6y ago
Why not make a website that doesn't require Javascript?
- erikpukinskis 6y ago
  I love those kinds of sites. But realistically the main reason people don’t build that way is it’s harder to hire for that.
  - mattl 6y ago
    Really? Am I somehow worth more by not knowing React?
    - kbenson 6y ago
      If you apply to jobs where the stack advertised looks like it's from a decade or more ago, you might have to actually deal with technology from two to three decades ago (or not, but it's probably more likely). People like new things, and often switch jobs looking for something new, and in tech that's often new technology they've played with but not got a chance to use in production. Honestly, something that's advertised as ruby/python and HTML will probably put a lot of devs off that used to happily do that all day, and so a company might have to pay higher for good talent, or put up with worse talent applying for the same salary. You might actually be worth more not knowing react. Communicating that to prospective employers might be hard though. In other words, you can probably make really good money slinging COBOL if you know it and can communicate your talent sufficiently for the same reason, but more extreme.
    - CJefferson 6y ago
      You wouldn't be worth more as a carpenter if you didn't know how to use a hammer. (I'm not saying React is as useful as a hammer, but if it genuinely makes building and maintaining websites faster, it's a skill worth paying for).
onetimeusename 6y ago
What do you mean by "monopolistic middlemen"? Who are these people and how do they manage to make drug prices higher?
- alexosh1 6y ago
  Short answer... it's complicated. And it's intentionally complicated to make it difficult for people to understand how they are getting ripped off on the price of drugs and by who. Here's a brief video that breaks down some of it though: https://www.youtube.com/watch?v=15IQO_jTMUM https://www.youtube.com/watch?v=15IQO_jTMUM
wombatmobile 6y ago
Have you studied healthcare/drug distribution in other countries? If so, could you identify things that work from those examples, and comment on why the USA lacks those characteristics, and how your new venture might go some way towards making amends?
- alexosh1 6y ago
  The US is kind of unique in a lot of its healthcare dysfunctions and there are a lot of individual policies that might help. For example, one thing most other developed countries do is have a central state agency negotiate prices for drugs for the whole country at once, which exerts a lot of buying power to drive costs down. The idea of Medicare in the US doing that has been proposed several times, but has been blocked, most famously during the initial ObamaCare debate. The stated reason for blocking that is that decreasing reimbursements would decrease the profit motive for pharma companies to innovate and create new drugs. The more practical reason is.... probably just that lobbyists exist. But that is just one policy among many. We are simple folk here at the MCCPDC, we just charge less. :-)
jennyyang 6y ago
Do you check for impurities in the drugs? One of the biggest issues these days is impurities of carcinogenic chemicals in many of the generic drugs.
- metiscus 6y ago
  If you are referring to the issues with Ranitidine, it is erroneous to consider that a generic drug problem. Research has shown that the NDMA is a degradation product of the drug itself and that the brand of the preparation does not affect it.
  - Scoundreller 6y ago
    Maybe for ranitidine, but for the ARBs (common blood pressure treatment drugs) that are a few decades old, the NMxA source was sourced from a new synthetic route and that's when they appeared in the drug supply: "It believes there has been NDMA contamination in those drugs for up to four years." https://www.lexology.com/library/detail.aspx?g=fcf817fe-192b-4ce1-8af6-4e808b90b3ef https://www.lexology.com/library/detail.aspx?g=fcf817fe-192b... > Ultimately, scientists traced the contamination back to a change in valsartan’s synthesis. The antihypertensive drug contains a tetrazole ring, which is an aromatic five-membered ring with one carbon atom and four nitrogens. For many years, the synthesis for this compound, developed by Novartis, used tributyltin azide to form the tetrazole, with xylene as a solvent. However, in 2014, China’s Zhejiang Huahai Pharmaceutical, which makes valsartan for some companies, filed a patent for an improved method for forming the tetrazole ring. https://cen.acs.org/pharmaceuticals/pharmaceutical-chemicals/NDMA-contaminant-found-multiple-drugs/98/i15 https://cen.acs.org/pharmaceuticals/pharmaceutical-chemicals...
  - jennyyang 6y ago
    It's not just Ranitidine. It's all blood pressure medications like Valsartan, losartan and irbesartan, and metformin the diabetes drug. These are just the ones that have been tracked. Sometimes the drugs come in with higher doses than they should, or less than they should. Or sometimes the pills are mislabeled.
inter_netuser 6y ago
how can you compete with generics giants such as Teva, or even the entire Indian industry?
wincy 6y ago
Hi Alex, do you have any plans on selling or attempting to get FDA approval for drugs that are used and known to be safe in other countries, such as the UK? Our daughter has a life threatening condition that I’ve posted a lot about on, a complication from spina bifida where she holds her breath when she gets upset. Many kids die from the condition. There’s a medication, piracetam, that a child with the same complication uses in the UK. It’s safe and has greatly helped the little girl in the UK. When we mentioned it to doctors we were immediately shut down and told it was impossible to get in the US. Any chance of the Mark Cuban Cost Plus Drug Company seeking FDA approval for piracetam and drugs like it?
- acangiano 6y ago
  Stories like this would be a game changer for this new company. I genuinely hope they go for it. In a way, it's surprising that there isn't a charity dedicated to this type of effort for drugs considered safe.
  - wincy 6y ago
    The Wikipedia page [0] says piracetam has been around since the 1950s, and was used to treat epilepsy as early as the 50s. Our daughter’s PEAC [1] is a rare complication of a relatively rare disease. From my very limited understanding of the regulations, a company would have to spend the million+ dollars it costs to get FDA approval, but then wouldn’t be able to recoup that cost by selling the drug exclusively because the patent has long since expired. The US has this class of drugs that just never got approved and no drug company will ever pay to get approved, even if they are commonplace in other nations. [0] https://en.m.wikipedia.org/wiki/Piracetam https://en.m.wikipedia.org/wiki/Piracetam [1] https://medcraveonline.com/JPNC/peac-prolonged-expiratory-apnoea-with-cyanosis-in-arnold-chiari-ii-malformation.html https://medcraveonline.com/JPNC/peac-prolonged-expiratory-ap...
    - desine 6y ago
      I had to check if it would fall under Trump's Right to Try Act [0], but sadly it doesn't seem like it would meet the requirements. Perhaps this is something we can continue pushing for more freedom enabling legislation though. [0] https://www.fda.gov/patients/learn-about-expanded-access-and-other-treatment-options/right-try https://www.fda.gov/patients/learn-about-expanded-access-and...
pkphilip 6y ago
Excellent project! Do you guys plan on making insulin more affordable in the US?
- randcraw 6y ago
  Or epinephrine (e.g. EpiPens)?
santoleo 6y ago
Hey Alex, I’m the Founder of mailmyprescriptions.com (now rebranded as geniusrx.com) the second online pharmacy / first wholesale online pharmacy (similar cost plus model) - just sent you an email. Love what you guys are doing, would love to help. Keep driving those prices down!!
Wolfenstein98k 6y ago
How will you avoid shortages, when the returns to drugs with chronic shortages are no better than those to drugs with plentiful supply on the market already?
gustaf 6y ago
Congrats on the launch Alex - very happy for you and everyone you will be able to serve! /Gustaf
tjbiddle 6y ago
Excuse my ignorance of all this: I'm assuming most drugs are priced high to start due to the R&D costs, and (I hope) they eventually decrease their costs over time as that's recouped. If Cost Plus comes in and reduces the costs significantly, then the original manufacturer has no incentive to create these medicines to start. Or is that not at all how this works :-)
- wavesplash 6y ago
  You’re on the right track, but there’s a big difference between under patent and post-patent expiry drugs. Patents last 20 years, so if you invent a drug, patent it, then go through FDA approval, you can charge whatever price you want to recoup development cost until the patent expires. After the patent expires other firms can make ‘generic’ versions of the drug without having to license it. The goal with generics was traditionally take expensive patent drugs and make them more affordable while still retaining reasonable profit - in theory multiple drug makers would create an efficient market price. However, many generics for critical but low volume drugs have become single sourced, and there has been a move over the last 20 years for single sourced drugs to dramatically raise their prices and bleed insurance companies and the unlucky individuals that aren’t covered by insurance. This is what MCDC are fighting.
- yaur 6y ago
  That's the first approximation estimate, But drug production requires a significant fixed investment to build the "factory" for the drug in the first place. Drugs with crazy prices tend to be those where a rational actor would choose to invest in a safer investment instead of expanding the supply, because they are being priced by people who are smart enough to make sure that is true.
amir734jj 6y ago
I would love to help as a software developer but I'm super busy with school and my PhD studies. Best of luck! Please make the repos publicly available so we can contribute for the greater good.
anilgulecha 6y ago
Hi Alex, How is the example cost of Albendazole right? Technically, it's a generic drug, and the cost is 10c (locally in India, atleast). What marks this up 130x in the US? [1] eg: https://www.1mg.com/drugs/zentel-tablet-137773 https://www.1mg.com/drugs/zentel-tablet-137773
- jmcgough 6y ago
  Pharmaceutical companies in the US charge whatever they can get away with, with the argument that insurance will cover it for most people. The price of insulin (clearly not a new drug) has increased 10x in the last 15 years.
  - WillPostForFood 6y ago
    The price of insulin (clearly not a new drug) This is a misconception. There are dozens of different drugs people refer to as Insulin, some new insulin analogs are better, and expensive. You can still get old synthetic formulations very cheaply. Walmart famously sells them for $25. https://www.medicalnewstoday.com/articles/311300#drugs-for-type-1-diabetes https://www.medicalnewstoday.com/articles/311300#drugs-for-t...
    - C4stor 6y ago
      How is $25 "very cheaply" ? That's already super expensive !
      - shanehoban 6y ago
        It's absolutely insane really. $25 is not cheap for something you need to live. Sometimes I'm so happy to live in Ireland, I know we have our faults. But at least with some things, we seem to get it right. Diabetics in Ireland have 0 cost associated with it. They can go to any pharmacy, and get anything related to Diabetes for free, and as much of it as they need. This should be the case for any life long illness - or any illness for that matter, in any country; in my opinion. Healthcare should be free for all, it amazes me that this is not yet the case. I do know deep down that it will be eventually though.
ralusek 6y ago
What's the tech stack?
KoftaBob 6y ago
If I'm understanding correctly, once a drug patent expires there are 2 possibilities: 1) The FDA grants a single company the exclusive right to manufacture, distribute, market and sell a generic version of a drug. In this case, the price will be lower than the brand drug, but not by much, since there's only one maker and no competition. 2) Several drug companies are allowed to design their own versions of the brand drug. Because there are several competing brands with essentially the same product in the marketplace, competition causes the prices drop. If your company targets the first type, you replace another company as the sole producer of the generic, and there's still no competition to drive the price down. If you target the second type, you become an additional competitor to the other generic drug makers, so the market gets a bit more competitive, but the prices in theory were already competitive because of the number of makers. For example, the Lexapro generic Escitalopram has many makers, so you can get it for as low as $10. So in terms of generics, the options are either single source agreements where pricing won't be competitive by design, or multiple makers, where the pricing is likely already competitive. Having said that, which of those does your company want to target, and how do they plan to tackle it?
- thw0rted 6y ago
  I don't know if this question was asked before the question was asked upthread ("how do we know you won't cave to investor pressure to raise profits?", basically) but the answer was that they're chartered as a "public benefit corporation" and that comes with a legal requirement to "maintain the social mission". So, if they're targeting the first type, the theory is that you don't need market pressure to drive the price down because they're only "allowed" to make enough margin to cover expenses.
- randcraw 6y ago
  If they target the first type, won't there be TWO competitors where there used to be a monopoly? Shouldn't prices then come down? As to the second type, just because there's an oligopoly doesn't mean competition will ensue and prices must drop. Look at the insane price on insulins. I suspect their intended mission is to cover their costs with only a modest profit and thereby drive down prices where they are most inflated. Given the proliferation of people like Martin Shkreli and companies like Purdue, there's a lot of pharmaceutical fruit out there to be pulled down and made low hanging once more.
avipars 6y ago
Is this a for profit at the end of the day? And can you export the drugs to other countries (for sale)?
goldforever 6y ago
Give it all to Mark. His vegan diet is making him start to look like an old lady - lol
lespaul114 6y ago
Hi do I have the ability to invest/buy stock of your company?! I am a huge fan of shark tank/especially Mark Cuban and would be excited to play a part in a company he also believes in. Even if it's just a miniscule role. Thank you!

evo_9 6y ago

Awesome project! What is the stack, what kind of developers are you looking for? Maybe post a link to your job listings.

alexosh1 6y ago
Currently our frontend is react, backend node.js, and a MySQL database with a graphql API (edit). Would be looking for folks to help make a more robust consumer facing site as we add products and different types of customers. We've been focusing mostly on filling roles for the sterile fill-finish facility we are constructing in Dallas (QA, formulation specialists, etc.) and have put building out the dev team for the web sit kind of on the backburner with me just kind of personally managing it at the moment. While Hacker News is looking though... :-)
- brianwawok 6y ago
  Why do you need a graph database to run a drugstore? You will save hundreds of thousands of dollars in development if you just use postgres...
  - erikpukinskis 6y ago
    GraphQL is not a database it’s just a wire protocol. You need a database behind it and Postgres is quite common. Compare it to JSON:API or GRPC. With Apollo it also solves a lot of frontend caching and state management problems so you can somewhat use it as an alternative to Redux.
  - juancampa 6y ago
    He probably meant a Graphql API in front of the DB (e.g. Hasura)
    - alexosh1 6y ago
      Oops, yeah sorry. Graphql API in front of MySQL
alexosh1 6y ago
O should also point out, these roles can be remote

benjismith 6y ago

Hi Alex, I just want you to know, I really admire what you're doing, and I hope you're wildly successful at it!

alexosh1 6y ago
Thanks Benjismith!

pyentropy 6y ago

Hey, I wrote about monoamine oxidase inhibitors on Scott Aaronson's blog a few months ago: https://www.scottaaronson.com/blog/?p=4933 https://www.scottaaronson.com/blog/?p=4933 Basically, there's is an international shortage for one of the most effective treatment for severe depression because of an unfortunate series of events, the drug's long history as a generic and the manufacturers' willingness to replace the drug class, and constantly produce new patented molecules with chemical tricks(ex. just taking one isomer in the citalopram->escitalopram case, or even metabolites in the case of venlafaxine -> desvenlafaxine case) like they are 'annual smartphone model releases', except efficacy even goes down. You can read more about it the drug itself on the blog of Scott Alexander (the rationalist/Bayesian psychiatrist guy) as well: https://slatestarcodex.com/2015/04/30/prescriptions-paradoxes-and-perversities/ https://slatestarcodex.com/2015/04/30/prescriptions-paradoxe... And now some years down the line after his observation, the price has exploded, very few new patients get a prescription due to uncertainty and there's no alternative. Your options are either taking taking an atypical antidepressant like vortioxetine or an experimental ketamine.

peteretep 6y ago
> monoamine oxidase inhibitors > citalopram ... venlafaxine God I hate myself for being that guy, but neither of the drugs you’ve listed are actually MAOIs. I’m sure the point still stands though.
- pyentropy 6y ago
  That's exactly the point. The selective classes (SNRI/SSRI) are marketed as a complete and safe replacement for MAOIs, on top of the chemical structure irony. Even the new atypicals with innovative chemical structure (and targets other than 5-HT1/SERT) are of significantly worse efficacy MAOIs I'll edit my parent comment to make it clearer.
  - peteretep 6y ago
    I don’t quite get the point you’re making then, as there’s a lot of generic citralopam on the market, despite escitralopam being patented.

eximius 6y ago

Are there any non-dev, remote roles needed?

loceng 6y ago

Not a question but a request: might not be a massively used drug, however pharmacies where I live don't seem to even carry the generic version of it, but dopamine agonists could use some competition.

stevebmark 6y ago

Will your company become obsolete once the US removes the ridiculous law that US citizens can't buy drugs from other countries? Every modern country has solved the low price drug problem except the US because of criminal and fraudulent healthcare laws.

alexosh1 6y ago
Ideally yeah, would be good if we didn't need to exist. There are a variety of policy initiatives the US could likely implement to bring costs down. My kind of mindset with the company though is I am a nobody from nowhere, and congress isn't going to listen to me. I can make cheap / sell medicine at an affordable price though. So I will do that. I'm not sure drug importation will work though, not because it's a bad policy per se, but I'm not sure that other countries will let the US import their low-cost medicines if US law changes in order to protect their domestic supplies. There's Canada as an example case. We have ~10x the population of Canada, and California alone could use up all of Canada's medicines. Not sure Canada would go for it. Think it's worth a shot though. I know there are some trial programs going into place in Colorado and Florida around allowing drug importation. Will be cool to follow and see how they play out.
- stevebmark 6y ago
  Makes sense, I always appreciate healthcare companies that capitalize on bad laws saying that ideally they wouldn't exist and they're trying to work within the existing framework. Cross-border drug buying works well in the EU, where any European country can buy drugs from any other European country, so whoever has the lowest price usually wins the market. As a private company, your incentive is to maximize profit for shareholders. Since all you have to do is undercut high drug prices a little, what will stop you from the same price gouging that all other US drug companies perform?
  - alexosh1 6y ago
    Well, there's some technical measures we've taken and some practical ones to ensure we work to be profitable but remain focused primarily on improving public health and helping patients. On the technical level, we incorporated as a public benefit corporation, so we are judged not only on how profitable we are for shareholders, but how well be maintain our social mission. That is actually in our charter documents and is a legal requirement. On a practical level, Mark Cuban is our lead investor and his interest is very much focused on helping people and fixing system issues in healthcare. We also did some screening to ensure our other investors are socially minded and prioritize social benefit as well as profits. My mindset is that we need to be profitable to be sustainable and grow enough to help the overall system, but we won't be extortionate.

cliff 6y ago

The website says you're planning to build your own manufacturing plant. What will that plant do? Will you actually be manufacturing your own medication? If so, would that include manufacturing the active pharmaceutical ingredients or will you be sourcing them from generic manufacturers and then making the final drugs at your plant?

alexosh1 6y ago
It will be a sterile fill-finish facility. The facility will fill vials of sterile injectable medicine. Those tend to be the drugs which are most affected by shortages and price gouging overall. The facility will just do finished drug products. Our initial drugs are supplied on "private label" arrangements where other companies actually do the manufacturing, and we just add our labels and our own NDC code so we can set the price. Since we don't go through middlemen, that price can often times be a lot lower. We'll have to source API (active pharmaceutical ingredients) elsewhere for now. At some point, would like to completely internalize our supply chain, but one step at a time. :-)
- voiper1 6y ago
  I know this is crazy, but have you talked with Bill Gates? He planned to pre-fund several coronavirus vaccine manufacturing plans _prior to FDA approval_ just to speed up vaccine production. He expected several of those would end up being wasted money. [1] Perhaps he would find this valuable too? [1] https://www.weforum.org/agenda/2020/04/bill-gates-7-potential-coronavirus-vaccines https://www.weforum.org/agenda/2020/04/bill-gates-7-potentia...

executive 6y ago

Why not make a website that doesn't require Javascript?

erikpukinskis 6y ago
I love those kinds of sites. But realistically the main reason people don’t build that way is it’s harder to hire for that.
- mattl 6y ago
  Really? Am I somehow worth more by not knowing React?
  - kbenson 6y ago
    If you apply to jobs where the stack advertised looks like it's from a decade or more ago, you might have to actually deal with technology from two to three decades ago (or not, but it's probably more likely). People like new things, and often switch jobs looking for something new, and in tech that's often new technology they've played with but not got a chance to use in production. Honestly, something that's advertised as ruby/python and HTML will probably put a lot of devs off that used to happily do that all day, and so a company might have to pay higher for good talent, or put up with worse talent applying for the same salary. You might actually be worth more not knowing react. Communicating that to prospective employers might be hard though. In other words, you can probably make really good money slinging COBOL if you know it and can communicate your talent sufficiently for the same reason, but more extreme.
  - CJefferson 6y ago
    You wouldn't be worth more as a carpenter if you didn't know how to use a hammer. (I'm not saying React is as useful as a hammer, but if it genuinely makes building and maintaining websites faster, it's a skill worth paying for).

onetimeusename 6y ago

What do you mean by "monopolistic middlemen"? Who are these people and how do they manage to make drug prices higher?

alexosh1 6y ago
Short answer... it's complicated. And it's intentionally complicated to make it difficult for people to understand how they are getting ripped off on the price of drugs and by who. Here's a brief video that breaks down some of it though: https://www.youtube.com/watch?v=15IQO_jTMUM https://www.youtube.com/watch?v=15IQO_jTMUM

wombatmobile 6y ago

Have you studied healthcare/drug distribution in other countries? If so, could you identify things that work from those examples, and comment on why the USA lacks those characteristics, and how your new venture might go some way towards making amends?

alexosh1 6y ago
The US is kind of unique in a lot of its healthcare dysfunctions and there are a lot of individual policies that might help. For example, one thing most other developed countries do is have a central state agency negotiate prices for drugs for the whole country at once, which exerts a lot of buying power to drive costs down. The idea of Medicare in the US doing that has been proposed several times, but has been blocked, most famously during the initial ObamaCare debate. The stated reason for blocking that is that decreasing reimbursements would decrease the profit motive for pharma companies to innovate and create new drugs. The more practical reason is.... probably just that lobbyists exist. But that is just one policy among many. We are simple folk here at the MCCPDC, we just charge less. :-)

jennyyang 6y ago

Do you check for impurities in the drugs? One of the biggest issues these days is impurities of carcinogenic chemicals in many of the generic drugs.

metiscus 6y ago
If you are referring to the issues with Ranitidine, it is erroneous to consider that a generic drug problem. Research has shown that the NDMA is a degradation product of the drug itself and that the brand of the preparation does not affect it.
- Scoundreller 6y ago
  Maybe for ranitidine, but for the ARBs (common blood pressure treatment drugs) that are a few decades old, the NMxA source was sourced from a new synthetic route and that's when they appeared in the drug supply: "It believes there has been NDMA contamination in those drugs for up to four years." https://www.lexology.com/library/detail.aspx?g=fcf817fe-192b-4ce1-8af6-4e808b90b3ef https://www.lexology.com/library/detail.aspx?g=fcf817fe-192b... > Ultimately, scientists traced the contamination back to a change in valsartan’s synthesis. The antihypertensive drug contains a tetrazole ring, which is an aromatic five-membered ring with one carbon atom and four nitrogens. For many years, the synthesis for this compound, developed by Novartis, used tributyltin azide to form the tetrazole, with xylene as a solvent. However, in 2014, China’s Zhejiang Huahai Pharmaceutical, which makes valsartan for some companies, filed a patent for an improved method for forming the tetrazole ring. https://cen.acs.org/pharmaceuticals/pharmaceutical-chemicals/NDMA-contaminant-found-multiple-drugs/98/i15 https://cen.acs.org/pharmaceuticals/pharmaceutical-chemicals...
- jennyyang 6y ago
  It's not just Ranitidine. It's all blood pressure medications like Valsartan, losartan and irbesartan, and metformin the diabetes drug. These are just the ones that have been tracked. Sometimes the drugs come in with higher doses than they should, or less than they should. Or sometimes the pills are mislabeled.

inter_netuser 6y ago

how can you compete with generics giants such as Teva, or even the entire Indian industry?

wincy 6y ago

Hi Alex, do you have any plans on selling or attempting to get FDA approval for drugs that are used and known to be safe in other countries, such as the UK? Our daughter has a life threatening condition that I’ve posted a lot about on, a complication from spina bifida where she holds her breath when she gets upset. Many kids die from the condition. There’s a medication, piracetam, that a child with the same complication uses in the UK. It’s safe and has greatly helped the little girl in the UK. When we mentioned it to doctors we were immediately shut down and told it was impossible to get in the US. Any chance of the Mark Cuban Cost Plus Drug Company seeking FDA approval for piracetam and drugs like it?

acangiano 6y ago
Stories like this would be a game changer for this new company. I genuinely hope they go for it. In a way, it's surprising that there isn't a charity dedicated to this type of effort for drugs considered safe.
- wincy 6y ago
  The Wikipedia page [0] says piracetam has been around since the 1950s, and was used to treat epilepsy as early as the 50s. Our daughter’s PEAC [1] is a rare complication of a relatively rare disease. From my very limited understanding of the regulations, a company would have to spend the million+ dollars it costs to get FDA approval, but then wouldn’t be able to recoup that cost by selling the drug exclusively because the patent has long since expired. The US has this class of drugs that just never got approved and no drug company will ever pay to get approved, even if they are commonplace in other nations. [0] https://en.m.wikipedia.org/wiki/Piracetam https://en.m.wikipedia.org/wiki/Piracetam [1] https://medcraveonline.com/JPNC/peac-prolonged-expiratory-apnoea-with-cyanosis-in-arnold-chiari-ii-malformation.html https://medcraveonline.com/JPNC/peac-prolonged-expiratory-ap...
  - desine 6y ago
    I had to check if it would fall under Trump's Right to Try Act [0], but sadly it doesn't seem like it would meet the requirements. Perhaps this is something we can continue pushing for more freedom enabling legislation though. [0] https://www.fda.gov/patients/learn-about-expanded-access-and-other-treatment-options/right-try https://www.fda.gov/patients/learn-about-expanded-access-and...

pkphilip 6y ago

Excellent project! Do you guys plan on making insulin more affordable in the US?

randcraw 6y ago
Or epinephrine (e.g. EpiPens)?

santoleo 6y ago

Hey Alex, I’m the Founder of mailmyprescriptions.com (now rebranded as geniusrx.com) the second online pharmacy / first wholesale online pharmacy (similar cost plus model) - just sent you an email. Love what you guys are doing, would love to help. Keep driving those prices down!!

Wolfenstein98k 6y ago

How will you avoid shortages, when the returns to drugs with chronic shortages are no better than those to drugs with plentiful supply on the market already?

gustaf 6y ago

Congrats on the launch Alex - very happy for you and everyone you will be able to serve! /Gustaf

tjbiddle 6y ago

Excuse my ignorance of all this: I'm assuming most drugs are priced high to start due to the R&D costs, and (I hope) they eventually decrease their costs over time as that's recouped. If Cost Plus comes in and reduces the costs significantly, then the original manufacturer has no incentive to create these medicines to start. Or is that not at all how this works :-)

wavesplash 6y ago
You’re on the right track, but there’s a big difference between under patent and post-patent expiry drugs. Patents last 20 years, so if you invent a drug, patent it, then go through FDA approval, you can charge whatever price you want to recoup development cost until the patent expires. After the patent expires other firms can make ‘generic’ versions of the drug without having to license it. The goal with generics was traditionally take expensive patent drugs and make them more affordable while still retaining reasonable profit - in theory multiple drug makers would create an efficient market price. However, many generics for critical but low volume drugs have become single sourced, and there has been a move over the last 20 years for single sourced drugs to dramatically raise their prices and bleed insurance companies and the unlucky individuals that aren’t covered by insurance. This is what MCDC are fighting.
yaur 6y ago
That's the first approximation estimate, But drug production requires a significant fixed investment to build the "factory" for the drug in the first place. Drugs with crazy prices tend to be those where a rational actor would choose to invest in a safer investment instead of expanding the supply, because they are being priced by people who are smart enough to make sure that is true.

amir734jj 6y ago

I would love to help as a software developer but I'm super busy with school and my PhD studies. Best of luck! Please make the repos publicly available so we can contribute for the greater good.

anilgulecha 6y ago

Hi Alex, How is the example cost of Albendazole right? Technically, it's a generic drug, and the cost is 10c (locally in India, atleast). What marks this up 130x in the US? [1] eg: https://www.1mg.com/drugs/zentel-tablet-137773 https://www.1mg.com/drugs/zentel-tablet-137773

jmcgough 6y ago
Pharmaceutical companies in the US charge whatever they can get away with, with the argument that insurance will cover it for most people. The price of insulin (clearly not a new drug) has increased 10x in the last 15 years.
- WillPostForFood 6y ago
  The price of insulin (clearly not a new drug) This is a misconception. There are dozens of different drugs people refer to as Insulin, some new insulin analogs are better, and expensive. You can still get old synthetic formulations very cheaply. Walmart famously sells them for $25. https://www.medicalnewstoday.com/articles/311300#drugs-for-type-1-diabetes https://www.medicalnewstoday.com/articles/311300#drugs-for-t...
  - C4stor 6y ago
    How is $25 "very cheaply" ? That's already super expensive !
    - shanehoban 6y ago
      It's absolutely insane really. $25 is not cheap for something you need to live. Sometimes I'm so happy to live in Ireland, I know we have our faults. But at least with some things, we seem to get it right. Diabetics in Ireland have 0 cost associated with it. They can go to any pharmacy, and get anything related to Diabetes for free, and as much of it as they need. This should be the case for any life long illness - or any illness for that matter, in any country; in my opinion. Healthcare should be free for all, it amazes me that this is not yet the case. I do know deep down that it will be eventually though.

ralusek 6y ago

What's the tech stack?

KoftaBob 6y ago

If I'm understanding correctly, once a drug patent expires there are 2 possibilities: 1) The FDA grants a single company the exclusive right to manufacture, distribute, market and sell a generic version of a drug. In this case, the price will be lower than the brand drug, but not by much, since there's only one maker and no competition. 2) Several drug companies are allowed to design their own versions of the brand drug. Because there are several competing brands with essentially the same product in the marketplace, competition causes the prices drop. If your company targets the first type, you replace another company as the sole producer of the generic, and there's still no competition to drive the price down. If you target the second type, you become an additional competitor to the other generic drug makers, so the market gets a bit more competitive, but the prices in theory were already competitive because of the number of makers. For example, the Lexapro generic Escitalopram has many makers, so you can get it for as low as $10. So in terms of generics, the options are either single source agreements where pricing won't be competitive by design, or multiple makers, where the pricing is likely already competitive. Having said that, which of those does your company want to target, and how do they plan to tackle it?

thw0rted 6y ago
I don't know if this question was asked before the question was asked upthread ("how do we know you won't cave to investor pressure to raise profits?", basically) but the answer was that they're chartered as a "public benefit corporation" and that comes with a legal requirement to "maintain the social mission". So, if they're targeting the first type, the theory is that you don't need market pressure to drive the price down because they're only "allowed" to make enough margin to cover expenses.
randcraw 6y ago
If they target the first type, won't there be TWO competitors where there used to be a monopoly? Shouldn't prices then come down? As to the second type, just because there's an oligopoly doesn't mean competition will ensue and prices must drop. Look at the insane price on insulins. I suspect their intended mission is to cover their costs with only a modest profit and thereby drive down prices where they are most inflated. Given the proliferation of people like Martin Shkreli and companies like Purdue, there's a lot of pharmaceutical fruit out there to be pulled down and made low hanging once more.

avipars 6y ago

Is this a for profit at the end of the day? And can you export the drugs to other countries (for sale)?

goldforever 6y ago

Give it all to Mark. His vegan diet is making him start to look like an old lady - lol

lespaul114 6y ago

Hi do I have the ability to invest/buy stock of your company?! I am a huge fan of shark tank/especially Mark Cuban and would be excited to play a part in a company he also believes in. Even if it's just a miniscule role. Thank you!