This week, we close out our three-part series on rethinking drug access and costs with a must-listen encore episode. After detailing the scope of the drug price crisis with Mark Cuban and how we can re-purpose drugs to treat rare illnesses with David Fajgenbaum, we turn to a leader who is actively changing the dynamic: Paul Markovich. Now the CEO of Ascendiun (the parent company of Blue Shield of California), Paul argues that healthcare affordability isn't just a patient pocketbook issue - it’s a massive economic crisis for the nation.

In this episode, Paul and Claudia discuss:

• His conviction that reducing healthcare costs is essential to averting a national fiscal crisis
• The upside-down economics that make PBMs reject cheaper drug prices
• Paul’s candid advice on what it takes to be a courageous leader in a dysfunctional system

Paul Markovich challenges healthcare leaders to shift from explaining high costs to being accountable for lowering them:

“Almost everybody in the entire value chain, whether it's health plans or hospitals or all the way through, they want to explain why healthcare is so expensive and why there's this inflation rate as if that absolves them of any responsibility to make it different. And so, what I really want is accountability, and a level of accountability that doesn't exist yet in our industry, to say, 'Hey, we own this' ".

Relevant Links

Part 1: Listen to our episode “New Life for Old Drug with David Fajgenbaum”

Part 2: Listen to our episode “Lessons in Disruption with Mark Cuban”

Rethinking how Americans get affordable medications

California’s new PBM reform law

About Our Guest

Paul Markovich is president and chief executive office of Ascendiun, a nonprofit corporate entity as part of the new parent to the family of organizations that includes Blue Shield of California.

Paul Markovich was president and chief executive officer at Blue Shield of California, a nonprofit health plan with $25 billion in annual revenue, serving 6 million members in the state's commercial, individual, and government markets. Paul launched and led numerous initiatives to drive innovation and help reimagine health care, including funding support for a statewide provider directory to make it easier for Californians to find physicians and facilities in their plan; supporting the development of a statewide health information network for patients’ records, enabling more seamless and holistic care; and investing in a partnership with the California Medical Association to help physicians pilot new care delivery models and leverage technology.

At Blue Shield, Paul previously served as chief operating officer (responsible for healthcare services, network management, e-business, marketing, product development, and customer operations). He was senior vice president of the large group and CalPERS business units. He led the company’s product development unit, introducing numerous products and services such as the first California Health Maintenance Organization to allow self-referrals to specialists and...

Investor and healthcare disruptor Mark Cuban joins The Other 80 to talk about his online pharmacy, Cost Plus Drugs, that is bringing affordable drugs with transparent markups to American households. Mark lays out his basic formula for taking overhead and complexity out of the US healthcare system by disaggregating huge vertical businesses and disintermediating middlemen.

In this episode, Mark Cuban pitches:

• That direct contracting with hospitals is his next healthcare disruption
• Why he thinks medical schools should be free
• How financial audits are a first step to lowering healthcare prices
• Why price transparency is contagious

Mark thinks the best way to make change is from outside the system:

“What makes [Cost Plus Drugs] radical is when we started, everybody presumed and expected that we would work within the system. That we would partner with the big three wholesalers that control 98% of the sale of drugs - that we would partner with the big three PBMs that control 85% of prescriptions. And, we did the exact opposite because we knew they were the problem.”

Relevant Links

• The Cost Plus Drugs mission statement
• Read and watch Mark Cuban testimony for the Senate Special Committee on Aging
• More on Mark’s hospital negotiation strategy

About Our Guest

Mark Cuban is an investor who lives for his family, his "Shark Tank" companies and the Dallas Mavericks. He is the owner of the 2011 World Champion Dallas Mavericks and bestselling author of "How to Win at the Sport of Business," and was an entrepreneur from the early age of 12 when he sold garbage bags door to door. Today, Cuban is the highly successful entrepreneur and investor with an ever-growing portfolio of businesses.

A lifelong entrepreneur and investor, Cuban has started and built multiple industry-changing organizations including Costplusdrugs.com, which sells medications at industry low pricing with total cost transparency, which he founded with Dr. Alex Oshmansky. Named a winner of the GQ Men of the Year in 2006 and included in The New York Times Magazine's Year in Ideas, Cuban is recognized as being among the most influential people in both the cable and sports industries. He may be best known for his purchase of the Dallas Mavericks on Jan. 4, 2000. Under his leadership, the team's home games have become a total entertainment experience.

Prior to his purchase of the Mavericks, Cuban co-founded the first commercial streaming company AudioNet, which became Broadcast.com, the leading provider of multimedia and streaming on the Internet. Broadcast.com was sold to Yahoo! Inc. in July 2000. MicroSolutions, a leading national systems integrator, was co-founded by Cuban and partner Martin Woodall in 1983, and later sold to CompuServe.

In 2001, Cuban founded AXS TV (www.axs.tv) and sister network, HDNet Movies, the very first all high-definition TV network. He also co-owns the Landmark Theater chain, Magnolia Pictures, Magnolia Home Video and 2929 Productions along with partner Todd Wagner. With the release of the movie "Bubble" in 2005, Magnolia and Landmark Theaters pioneered the release of the movie's "day and date," meaning the

When David Fajgenbaum nearly died of Castleman disease for the fifth time, he decided to take fate into his own hands. Using his medical training, he searched for an existing drug that might save his life—and found one. Now his organization, Every Cure, is scaling the same approach to uncover hidden treatments for other diseases with no known cure.

David and Claudia discussed:

• How Every Cure is using AI to test 75 million possible disease-drug combinations
• The perverse incentives that keep generic drug repurposing in the shadows
• Why the hardest part of innovation isn’t discovery, it’s getting proven treatments into clinical practice

Repurposing existing drugs makes so much sense. But as David points out, there’s no market for it:

“Once a drug is generic.. the price is going to plummet… And even if you were to double the sales of your drug because you found a new disease area, now you've gone from 1% to 2% of what you got before… So there's no incentive whatsoever for our system to find a new use for a generic drug. Zero incentive.”

Relevant Links

• Learn more about Every Cure
• Read David’s book Chasing My Cure: A Doctor’s Race to Turn Hope Into Action
• Watch David's TEDTalk
• Listen to David’s Podcast interview with Adam Grant
• Get info on the Dada2 Foundation
• Watch a video on Matt Might’s story

About Our Guest

David Fajgenbaum, MD, MBA, MSc, is co-Founder & President of Every Cure and a physician-scientist at the University of Pennsylvania, where he is one of the youngest faculty members ever to receive tenure at Penn Medicine. He is also the national bestselling author of Chasing My Cure: A Doctor’s Race to Turn Hope Into Action, which is being adapted into a film by Forrest Gump producer Wendy Finerman.

During medical school, Fajgenbaum discovered a treatment that saved his own life and founded the Castleman Disease Collaborative Network. He has advanced 13 more repurposed treatments for cancers and rare diseases and co-founded Every Cure to unlock more hidden cures from existing medicines which has received over $100M from ARPA-H and TED’s Audacious Project. He also serves on the Board of Directors for the Reagan-Udall Foundation for the FDA.

One of the youngest recipients of multiple top NIH and FDA grants, Fajgenbaum has authored over 100 scientific papers in leading journals, including The New England Journal of...