Mark Cuban upended prescription drug pricing in 2022 when he co-founded Cost Plus Drugs, an online pharmacy that posts its full price list publicly, charges a flat 15% markup and $5 shipping, and bypasses traditional pharmacy benefit managers and wholesalers entirely.
Now he’s applying the same transparency logic to how providers get paid.
His new platform, Cost Plus Wellness, connects self-insured employers directly with providers through publicly posted contracts, and the providers leading the way on the platform are predominantly ASCs and physician groups.
The platform currently lists 27 published contracts covering at least 9,200 providers and 193 facilities, concentrated largely in the Dallas-Fort Worth metro area, with more contracts expected to be added nationally. Contract types span single- and multispecialty groups, independent physician associations and facility-based providers. Baylor Scott & White Health was the first major system to sign on.
For ASCs and physician groups already operating on lean margins and tight administrative bandwidth, the platform’s terms address some of the most persistent pain points in commercial contracting. There are no balance billing provisions, no spread pricing, no prior authorization requirements and no hidden administrative fees. Employers and third-party administrators are contractually required to pay within 30 days of receiving a claim.
Nearly 75% of providers report an increase in claim denials, a 31% jump since 2022, according to a 2024 Experian Health survey. Additionally, 38% of respondents said their claims are denied 10% of the time or more, and 11% reported denial rates of 15% or more.
“Denials and post-payment audits are up, especially around medical necessity and site-of-service,” Phillip Blair, CEO of Mesa, Ariz., Surgery Center Services of America, told Becker’s. “What’s changed is the tone: Payers are less collaborative and more transactional than they were even a year ago.”
Mr. Cuban described the platform as an “open-source project” rather than a business at the Becker’s Spring Chief Pharmacy Officer Summit in Chicago April 15. The platform also distinguishes between contracts it has directly negotiated and “community contracts” — those self-published by providers using a Cost Plus Wellness template. Regardless of contract type, Mr. Cuban said the platform bars insurers from using any of its contracts.
His pitch to ASCs and physician practices cuts to the core of how many high-volume facilities actually evaluate their payer mix. Once you account for denials, clawbacks, late payments and legal and administrative costs, your highest-volume commercial payer relationships may also be your least profitable.
Commercial reimbursement drives ASC profitability. Commercial rates average around 196% of Medicare FFS, while Medicare pays ASCs only 53% to 56% of what it pays hospital outpatient departments, according to 2025 data from insurance company Milliman.
“If you literally did a cost analysis and a profitability analysis by insurance carrier, the biggest ones are where you’re going to be losing the most money,” Mr. Cuban said. “Don’t be afraid of the daily patient count because you think you’ve got all this capex and you need bodies coming through the door. Just making sales and losing money is not making money.”
Because the ASC model is already built around cost efficiency and streamlined care delivery, direct contracting platforms like Cost Plus Wellness represent a potential alignment between how ASCs operate and how they get paid.
At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.