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Episode
Estrogen Patch Shortage: Who Profits From Your Prescriptions with Mark Cuban
~79 min
Episode Brief·YouTube

Estrogen Patch Shortage: Who Profits From Your Prescriptions with Mark Cuban

Mary Claire Haver
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TL;DR

The four things you'd lose by not watching

4 items

TL;DR

The four things you'd lose by not watching

4 items
1

Estrogen patch shortage driven by demand surge (3x in 2 years) and limited manufacturing capacity; Cost Plus Drugs is buying up all available inventory to maintain supply.

2

The US drug pricing system is opaque, with PBMs (pharmacy benefit managers) extracting rebates and inflating prices; Cost Plus Drugs offers transparent pricing with 15% markup.

3

Vaginal estrogen cream is extremely affordable at Cost Plus ($13.21) vs hundreds elsewhere, potentially saving Medicare billions in UTI/sepsis costs.

4

Mark Cuban advises using multiple AI tools (Claude, ChatGPT, Gemini) to decipher health plan details and find affordable care options.

Protocols

Concrete recipes — what, when, how much, and why

5 items

Use Cost Plus Drugs for affordable prescriptions

WhatGo to costplusdrugs.com, search for medication, see transparent price, have doctor send prescription.
WhenWhen filling any prescription, especially generics.
For whomAnyone paying out-of-pocket or with high deductible.
WhyTransparent pricing with 15% markup, often cheaper than insurance copay.
CaveatsDoes not carry controlled substances; some brand drugs not available.

Cuban explains they show actual cost, markup, pharmacy labor, shipping. Example: estrogen patch $39.18 vs retail $185.87. They source multiple manufacturers to maintain supply.

Personal experience

Dr. Haver: 'I've done it online and showed people how to do it.'

You just go to costplusdrugs.com. You sign up, you find the med, you put in your credit card, you tell your doctor where to send it, and that's it.

Also said
“We show you our actual cost when you put in a drug... and it comes up we'll show you what our cost is what our markup is.”— Illustrates transparency.

Use multiple AI tools to understand health plan details

WhatInput your health plan documents into Claude, ChatGPT, Gemini and ask questions about coverage, tiers, prices.
WhenWhen trying to understand prescription coverage or find affordable care.
For whomAnyone with health insurance, especially those with complex plans.
WhyAI can parse fine print and answer specific questions; cross-checking reduces errors.
CaveatsAI may not be 100% accurate; use multiple and challenge them.

Cuban advises using free interfaces of Claude, ChatGPT, Gemini. Ask same question to each, then have them fact-check each other. Example: 'Is my estradiol covered? What tier? Where can I buy it?' Also use AI to find charity care options at nonprofit hospitals.

Personal experience

Cuban: 'I use it. Does cost plus drugs carry it? All those things I use it for.'

Use the free interface for Claude and ChatGPT and Gemini and ask the same question to each. It's like if you have three friends just sitting there... they're all going to be a little bit right.

Also said
“They can fact check each other and you can use your common sense to make a determination.”— Emphasizes cross-validation.

Check Cost Plus Drugs for estrogen patch availability during shortage

WhatVisit costplusdrugs.com to see if patches are in stock; they may have multiple price options.
WhenWhen unable to find patches at local pharmacy.
For whomWomen prescribed estrogen patches.
WhyCost Plus sources from multiple manufacturers and buys up inventory.
CaveatsMay have higher price option if cheaper one out of stock, but still cheaper than retail.

Cuban explains they have two vendors with different pricing; they offer both and let patient choose. They are trying to buy out entire volumes from manufacturers.

We made the conscious decision to say even if we run out of inventory of the less expensive one, we're going to explain to people that look, we want to make sure that there's inventory available, our most expensive version is still less expensive than most retailies.

Also said
“We've gone to the two major manufacturers and said, 'Look, we will take every unit of inventory that you're able to give us.'”— Shows proactive approach.

Seek charity care at nonprofit hospitals if uninsured

WhatGo to a nonprofit hospital and request a payment plan or charity care; they are required to offer it.
WhenWhen needing medical care but cannot afford it.
For whomUninsured or underinsured individuals.
WhyNonprofit hospitals must provide charity care to maintain tax-exempt status.
CaveatsEmergency rooms only stabilize; better to go to nonprofit hospital for non-emergency.

Cuban explains that federally qualified health centers also must see patients regardless of ability to pay. Use AI to find options.

If you go to a nonprofit hospital and you say, 'Hey, here's what I'm facing. I can't afford it. I'll work on your schedule.' ... they're supposed to work out a payment plan and work with you.

Also said
“Don't ever not get care.”— Encouragement.

Buy multiple months of medication when possible

WhatIf you can afford it, purchase several months' supply to buffer against shortages.
WhenWhen medication is available and affordable.
For whomAnyone on chronic medication.
WhyShortages can occur; having stock ensures continuity.
CaveatsCheck expiration and storage requirements.

Cuban: 'If you're responsible enough to buy multiple months and store it properly, always buy as much as you can afford.'

Always buy as much as you can afford.

What's new

Personal practice updates, fresh positions, predictions

6 items

Estrogen patch shortage driven by demand surge and manufacturing lag

early in transcript

Prescriptions for estrogen patches have nearly tripled in two years, but manufacturers did not anticipate the surge, leading to shortages. Cost Plus Drugs has sourced multiple manufacturers and buys up all available inventory.

Why this matters: Highlights systemic failure in supply chain for a critical menopause therapy; FDA initially denied shortage but later acknowledged.

Background

Before the shortage, estrogen patch demand was stable; after Blackbox Morning and increased awareness, demand exploded.

Mark Cuban explains that oral estrogen is easy to make, but patches require specialized manufacturing. Demand at Cost Plus increased at least 10x. They tried to buy manufacturers but couldn't. They now source from two vendors with different pricing, offering both options to patients. The FDA only recently changed its website to acknowledge the shortage and is working with six manufacturers to increase capacity.

Personal experience

Cuban: 'We literally tried to buy manufacturers. I've tried to buy a manufact... I would if I could.'

It's on short supply because money. Yes. If it's harder to get, you can price it more.

Also said
“The demand isn't going to go down. No, for menopause hormone therapy. I only predict it getting increasing... we had about 40% of women who were eligible on hormone therapy. We're still less than 10%.”— Shows future demand will only increase, exacerbating shortage.

Cost Plus Drugs transparent pricing with 15% markup

mid transcript

Cost Plus Drugs shows actual cost, 15% markup, and pharmacy labor fee, resulting in significantly lower prices than retail.

Why this matters: Radical transparency in an opaque industry; builds trust.

Background

Before Cost Plus, patients had no idea of drug costs; retail pharmacies charge variable prices.

Cuban explains that trust equals transparency divided by self-interest. They launched with 110 drugs, now thousands. They don't spend on marketing, relying on word-of-mouth. Their pricing is the same for everyone regardless of location. Example: estrogen patch generic at $39.18 vs retail $185.87.

Personal experience

Cuban: 'My next dollar is not going to change my life, but my next dollar might save somebody's life.'

We wanted to be completely transparent because what was truly missing was is and was trust.

Also said
“It shows you our markup's only 15%. Which is about as little self-interest as somebody can afford to do and still stay in business.”— Explains the business model.

Pharmacy Benefit Managers (PBMs) inflate drug prices through rebates and formulary access fees

later in transcript

PBMs charge manufacturers for formulary placement, leading to high list prices and rebates that don't benefit patients.

Why this matters: Reveals hidden middlemen driving up costs; Cuban explains how brand drugs are priced artificially high.

Background

PBMs originally processed claims, now control formularies and negotiate rebates.

Cuban describes a conversation with a company selling a non-opioid pain med: PBMs demanded they raise price from under $200 to $700, with most as rebate, or be blocked. For brand drugs, manufacturers sell to distributors at a discount, but the list price is inflated to cover rebates to PBMs. This delta is the middleman profit. Cuban: 'If you took out the middlemen... prices would go down.'

They told me that the PBMs... unless they raised the price... to $700, with most of that being rebate, not only would they not put them on the formulary, but they will block them otherwise.

Also said
“The manufacturer of that brand testosterone isn't making $570. They are only making $300... they have to take that delta and pay it to the pharmacy benefit managers.”— Illustrates the hidden cost structure.

Vaginal estrogen cream affordability at Cost Plus Drugs

mid transcript

Cost Plus Drugs sells vaginal estrogen cream for $13.21, compared to hundreds at retail, making it accessible for recurrent UTI prevention.

Why this matters: Could save Medicare billions; Dr. Haver emphasizes it's a preventative treatment for sepsis.

Background

Previously, patients couldn't afford it; Dr. Rubin alerted Cuban.

Dr. Haver: 'If every single post-menopausal patient over 65 used vaginal estrogen regularly, we could save Medicare billions in urosepsis and hospitalizations.' Cuban suggests connecting with Dr. Allison Galvani to study Medicare impact.

You were the first person to make this affordable.

Also said
“It is the number one preventative treatment for recurrent UTI, which then can lead to sepsis and death.”— Highlights medical importance.

Underfunding of women's health research

later in transcript

Less than 9% of NIH grant money goes to women's health; attributed to systemic bias and male-dominated decision-making.

Why this matters: Quantifies disparity; connects to broader healthcare neglect.

Background

Dr. Haver mentions she trained in system and took 20 years to realize bias.

Cuban: 'It's run by men.' He says most people just go to work and don't think about changing the system. NIH grant decisions follow path of least resistance. He sees opportunity in fixing screwed-up areas.

Personal experience

Dr. Haver: 'I hate to keep saying patriarchy, but I grew up in the system. I was trained in the system. And it took me 20 years of practice to realize how much bias was built into this system.'

It's run by men.

Also said
“Less than 9% of NIH grant money went to women's health over the last decade. Why do you think that is?”— Directly states the statistic.

No FDA-approved testosterone product for women in the US

near end

Testosterone is prescribed off-label using men's versions; FDA held hearing on approval.

Why this matters: Highlights regulatory gap; women have to titrate men's doses.

Background

Men need 10x the dose; women use off-label.

Dr. Haver: 'We don't have an FDA approved testosterone product for women in this country.' Cuban: 'Somebody's got to make the time and investment to go get all the approvals.' He notes FDA is not the inhibitor unless making many drugs.

We don't have an FDA approved testosterone product for women in this country.

Also said
“Men need 10 times the amount in general that women do. And so having to titrate the pump can be a little sketchy.”— Explains clinical challenge.

Recommendations

Products, supplements, and tools mentioned in the episode

1 item

Claude, ChatGPT, Gemini

Tool

Free AI chatbots to help decipher health plan details, find affordable care options.

Cuban advises using all three and cross-checking. Can input plan documents and ask specific questions.

vs alternatives

Multiple AIs reduce risk of misinformation.

Personal experience

Cuban uses them himself.

Use the free interface for Claude and ChatGPT and Gemini and ask the same question to each.

Find Claude,
Disclosed sponsorships7speaker disclosed

Cost Plus Drugs

Service Sponsored · disclosed

Online pharmacy with transparent pricing, 15% markup, shows actual cost.

DisclosureMark Cuban is co-founder of Cost Plus Drugs.

Already covered in protocols; here as a recommended service.

vs alternatives

Much cheaper than retail pharmacies; often cheaper than insurance copay.

Personal experience

Dr. Haver uses it and recommends it.

We show you our actual cost... and it comes up we'll show you what our cost is what our markup is.

Find Cost

Midi Health

Service Sponsored · disclosed

Virtual menopause clinic offering personalized care, covered by most insurance.

DisclosureSponsored segment; Dr. Haver is a paid endorser.

Dr. Haver describes it as part of menopause toolkit. They treat GSM, hormone therapy, etc.

Personal experience

Dr. Haver recommends it.

Midi specializes in caring for women during midlife and menopause, including conditions like GSM.

Find Midi

Whoop 5.0 Wearable

Product Sponsored · disclosed

Wearable health and fitness coach tracking sleep, recovery, strain.

DisclosureSponsored segment.

Dr. Haver mentions using it for hiking and travel to understand body response.

Personal experience

Dr. Haver: 'I'm always looking for ways to better understand how my body is responding.'

It could give me insights into my sleep recovery and strain.

Find Whoop

Chronometer

Tool Sponsored · disclosed

Nutrition tracking app that tracks soluble and insoluble fiber, micronutrients.

DisclosureSponsored segment.

Dr. Haver uses it to see fiber intake; tracks both soluble and insoluble.

vs alternatives

More detailed than calorie-only apps.

Personal experience

Dr. Haver: 'I especially appreciate that it tracks both soluble and insoluble fiber.'

It makes it incredibly easy to actually see what you're eating and understand your nutrition on a deeper level.

Find Chronometer

Alloy Health M4 Skincare

Service Sponsored · disclosed

Prescription-strength skincare for perimenopause and menopause, including face cream, neck, chest, hands.

DisclosureSponsored segment; code MCH20 for 20% off.

Clinical study: 88% of women reported improved elasticity with M4 face cream. Connects with menopause-specialized doctor.

Personal experience

Dr. Haver: 'When hormones are part of the equation, skincare alone may not be enough.'

In a clinical study, 88% of women reported improved elasticity with M4 face cream.

Find Alloy

Quint Mongolian Cashmere

Product Sponsored · disclosed

Affordable cashmere sweaters and essentials, 50-80% less than luxury brands.

DisclosureSponsored segment; free shipping, 365-day returns.

Dr. Haver mentions using them for fall wardrobe.

vs alternatives

50-80% less than comparable luxury brands.

Personal experience

Dr. Haver: 'I'm especially looking forward to pulling out my Quint Mongolian cashmere sweaters.'

They focus on the everyday essentials that we actually wear using elevated materials... while keeping the prices remarkably accessible.

Find Quint

Withings Body Scan 2

Product Sponsored · disclosed

Medical-grade body composition scale with 6-lead ECG, AI detection, tracks muscle mass, visceral fat, bone mass, vascular age.

DisclosureSponsored segment; promo code UNPAUSED for 10% off.

Dr. Haver emphasizes tracking bone mass during menopause. Provides data for doctor discussions.

vs alternatives

Goes beyond basic scale.

Personal experience

Dr. Haver: 'It brings the same grounded data-driven clarity to your health that I strive to bring to my practice every day.'

It goes far beyond the basic scale by providing medical grade six zone segmental body composition insights.

Find Withings

Notable quotes

Lines worth pulling out — contrarian, specific, or perfectly phrased

6 items
It's a scam from top to bottom. Nobody looks at the economics of healthcare and says it's working well.
Summarizes the systemic problem.
My next dollar is not going to change my life, but my next dollar might save somebody's life.
Cuban's motivation.
It's on short supply because money. Yes. If it's harder to get, you can price it more.
Blunt explanation of shortage economics.
These middlemen too big to care.
Captures PBM indifference.
Less than 9% of NIH grant money went to women's health over the last decade. Why do you think that is? It's run by men.
Direct attribution of funding disparity.
The prescription drug industry is the easiest industry you've ever disrupted.
Cuban's confidence in transparency model.

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Topics covered

estrogen-patch-shortagecost-plus-drugstransparent-pricingpharmacy-benefit-managersdrug-rebatesvaginal-estrogenmenopause-hormone-therapywomen-health-fundingtestosterone-for-womenendometriosisai-health-plan-navigationnonprofit-hospital-charity-caregeneric-drug-pricingspecialty-drugsmenopause-gold-rush
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