U.S. Senators Josh Hawley (R-MO) and Elizabeth Warren (D-MA) yesterday introduced a bipartisan bill, the “Break Up Big Medicine Act,” to break up health care conglomerates and force the separation of insurance companies, healthcare providers, and Pharmacy Benefits Managers (PBMs).
According to the Senators’ joint press release, “Giant health care conglomerates dominate the American health care system. The three largest pharmacy benefit managers (PBMs) manage 80% of prescription drug claims, while just three prescription drug wholesalers control 98% of U.S. drug distribution. These corporate entities are vertically integrated, meaning one company can own or control every part of the health care supply chain—from health insurance companies and PBMs to pharmacists and physicians. By controlling both the company that pays for health care services (e.g., a health insurer) and also the entity that sets the prices for those health care services (e.g., a health care provider), these conglomerates may be steering business to their own affiliates, evading laws intended to rein in corporate profiteering, or using providers they employ to boost government payments and pad their bottom lines.”
Billionaire Mark Cuban, owner of Cost Plus Drugs, who has been an advocate for getting rid of the “middlemen” — PBMs including CVS Caremark, Express Scripts, and OptumRx — responded with approval of the bill.
Cuban wrote to the Senators: “Great job @HawleyMO & @SenWarren LOVE THIS. Anyone in Congress that doesn’t support this, doesn’t want lower cost healthcare for Americans. This is a no brainer. Let’s hope @POTUS puts his weight behind this.”
Philadelphia cardiologist Dr. Anish Koka disagreed with Cuban and replied: “Really bad idea. The government has no business deciding which private businesses to break up. Just go after the myriad of regulations that leads to consolidation and keeps entry barriers for competition high.”
Really bad idea. The government has no business deciding which private business es to break up.
Just go after the myriad of regulations that leads to consolidation and keeps entry barriers for competition high. https://t.co/cK9t5RKhgy
— Anish Koka, MD (@anish_koka) February 10, 2026
Cuban replied to Dr. Koka: “Is it feasible that a company can be so big, and government so incapable, that the company has more control over an industry than the federal government? Is it possible that gov mistakes allowed that company to grow so big, that if they don’t break it up, the costs in that industry will continue to skyrocket? Do you think that if government mistakes created a behemoth that has captured regulation, and an industry, the people must be punished for allowing their legislators to make these mistakes, so there is nothing to do? Just let the behemoth continue as is?”
How is it possible that the same federal government you want to break up these behemoths cannot undo legislation that created these beasts?
Essential health benefits mandates insurance plans cover brand name and generic drugs.
The government is powerless to address that ?
Do…
— Anish Koka, MD (@anish_koka) February 11, 2026
Koka replied to Cuban: “How is it possible that the same federal government you want to break up these behemoths cannot undo legislation that created these beasts? Essential health benefits mandates insurance plans cover brand name and generic drugs. The government is powerless to address that? Do you trust the government to break up spaceX? Cheaper prices comes from lowering the barrier to entry for competitors, not empowering bureaucrats who couldn’t run a lemonade stand to break up company X.”
We got SpaceX which massively decreased the cost of space flight because the Obama administration opened up space flight to private companies.
Prior to SpaceX , the government handled human missions – which ended up being incredibly costly and tragically fatal — and the… pic.twitter.com/qIVBZfP4yC
— Anish Koka, MD (@anish_koka) February 11, 2026