In this episode of unPAUSED, Dr. Mary Claire Haver sits down with entrepreneur Mark Cuban, cofounder of the Mark Cuban Cost Plus Drug Company, to unpack the estrogen patch shortage and why so many women in perimenopause and menopause struggle to find and afford hormone therapy. Holding up her own patch, she asks the question her patients and followers keep asking: why is this so hard to get?

Mark explains why the estrogen patch shortage has hit so hard. Patches require specialized manufacturing that pills do not, demand for menopause hormone therapy, or HRT, surged after the black box warning was removed, and supply could not keep up. He describes how his pharmacy has worked to buy every patch manufacturers can produce, why prices can differ between suppliers, what the FDA can do to help, and who gets served first when a generic drug runs short.

The conversation also takes apart how prescription drug prices are set in the United States. Mark breaks down how pharmacy benefit managers, or PBMs, build the formularies that decide which drugs your insurance covers, how manufacturer rebates can drive list prices higher, and why a handful of healthcare conglomerates now own insurers, pharmacies, PBMs, and physician practices all at once. Using a hypothetical testosterone therapy for women, he traces where every dollar goes between manufacturer, distributor, and pharmacy, and explains why generic, brand name, and so called specialty drugs are priced so differently. Together they pull up the Cost Plus Drugs website to compare what a generic estradiol patch costs to make with what many women pay at a retail pharmacy.

Dr. Haver makes the case for vaginal estrogen as one of the most affordable and effective treatments for genitourinary syndrome of menopause and for preventing recurrent urinary tract infections in older women. They also discuss why there is still no FDA approved testosterone for women, why women's health research remains underfunded, the long road to an endometriosis diagnosis, and how untreated menopause symptoms push experienced women out of the workforce.

Mark explains that employers who pay their own health claims hold enormous power to change the system, and he explains how AI can help companies spot costly terms buried in benefit contracts hundreds of pages long.

The episode closes with practical ways to lower your prescription costs: ask your doctor about a 90 day supply, learn what your health plan covers and how your medications are tiered, compare cash prices with your copay, know what nonprofit hospitals are expected to offer patients who cannot afford care, and use more than one AI tool to double check what you learn about your coverage.

Guest links:

• Mark Cuban Companies
  
• Cost Plus Drug Company
  
• Mark Cuban (Facebook)
  
• Mark Cuban (LinkedIn)
  
• Mark Cuban (Instagram)
  
• Mark Cuban (X)

Recommended Books:

• “The New Perimenopause,” by Dr. Mary Claire Haver
  
• “The New Menopause"⁠ by Dr. Mary Claire Haver

Articles:

• Menopausal Hormone Therapy Use Among Postmenopausal Women (JAMA)

Other Resources:

• FAQ (Cost Plus Drugs)
  
• Mark Cuban Explains His Battle Against Pharmacy Benefit Managers (Penn LDI)
  
• Related businesses and preservation of Medicare’s Medical Loss Ratio rules (Brookings)
  
• Medical Loss Ratio: Getting Your Money's Worth on Health Insurance (Centers for Medicare and Medicaid Services)
  
• The Medicare Advantage Program: Status Report (pg. 397)
  
• UnitedHealth Group’s 2025 Results (pg. 15, footnote a.)
  
• What Is a Health Insurance Formulary? (American Academy of Pediatrics)
  
• Modernizing and Clarifying the Physician Self-Referral Regulations Final Rule (CMS)
  
• Will pharmaceutical tariffs achieve their goals? (Brookings)
  
• International Prescription Drug Price Comparisons (RAND)
  
• US Drug Distribution (Morningstar)
  
• Experts Say the Estrogen Patch Shortage Could Last a Year—but the FDA Label Change Isn’t the Main Culprit (Inc.)
  
• Ask the FDA to declare an estradiol patch shortage (change.org)
  
• Alison Galvani, PhD (Yale University)
  
• Ozempic generic approved in Canada after Novo Nordisk doesn't pay $250 government fee (The BMJ)
  
• Canada approves second generic semaglutide, the first G7 country to do so (Government of Canada)
  
• A New Vision for Women's Health Research: Transformative Change at the National Institutes of Health, 2025 (The National Academies Press)
  
• FDA Public Meeting: Testosterone Use In Menopausal Women (FDA)
  
• The future of health is female: The impact of women+ health on our society (Deloitte)
  
• Many Women Enter Menopause Without Clear Information (Gallup)
  
• Menopause and the workplace (TUC)
  
• The Need to Make Insulin Affordable for All Americans (Senate Committee on Health, Education, Labor and Pensions)