Projected Savings for Urolithiasis Medications Purchased Through the Mark Cuban Cost Plus Drug Company in Medicare

Medical therapy is recommended in patients with urolithiasis at the risk of recurrence, but prices can remain prohibitively expensive. Direct-to-consumer outlets such as the Mark Cuban Cost Plus Drug Company (MCCPDC) offer opportunities for decreased Medicare Part D and beneficiary spending. We compared prices for generic urolithiasis preventative medications across insurance types and with over-the-counter potassium citrate supplements. We estimated potential savings if Medicare Part D plans obtained prices offered under MCCPDC.

We simulated the out-of-pocket price for a 90-day supply of 7 generic drugs of various public and private insurers/companies. Using the 2022 Medicare Part D Spending Dashboard and Q4-2024 Part D formulary and MCCPDC prices for 7 medications, we estimated Medicare savings by replacing Q4-2024 Part D unit costs with MCCPDC costs. For potassium citrate, we used price for 90-day supply to calculate cost per 10 mEq alkali citrate for each insurer/manufacturer.

Using MCCPDC prices, savings were generated for all drugs at the median prices under Part D except hydrochlorothiazide and tiopronin. Depending on dosage, estimated annual savings at the median percentile prices for Part D were allopurinol $2.3 to $15.7 million (M), chlorthalidone $14M to $26M, indapamide $0.9M to $1.7M, penicillamine $2.3M, and potassium citrate $12.1M to $19.1M. Cost per 10 mEq alkali citrate ranged from $0.03 to $1.07, whereas cost per 10 mEq alkali citrate for over-the-counter supplements ranged from $0.04 to $1.80.

Direct-to-consumer online pharmacies offer affordable alternatives for cash-paying customers purchasing urolithiasis medications. Replacing Part D formulary with MCCPDC pricing could yield significant savings for 5 generic urolithiasis medications.