Justin Mares

This account is verified. Learn more

@jwmares

Founder @truemed, @kettleandfire, @drinksurely, others. Venture partner @LongJourneyVC.

Sign up for my newsletter on health and startups:

Austin, TX justinmares.substack.com Joined May 2010

935 Following 48K Followers 6.3K Posts

Latest posts 5

Pinned post

Justin Mares @jwmares Dec 22, 2025

Today, 90%+ of healthcare spend (all $4.5T of it) goes towards treating chronic conditions after someone is sick.

Less than 3% of that spend goes towards prevention.

@Truemed exists to get more people investing in True Medicine. Exercise, food, supplements, movement, sleep, toxin removal… lifestyle interventions that help people treat and prevent disease, not just treat the symptoms of underlying sickness.

We’re building tools that allow qualified individuals to unlock the $160B in tax-free HSA/FSA funds, and use them on these root-cause interventions.

Since launching just 2.5 years ago, we’ve helped almost a million individuals pay for these interventions, and we’re just getting started.

If we want to fix healthcare in America, we fundamentally have to help Americans get healthier.

I’m extremely proud to announce our $34M Series A led by a16z, and am excited to continue our work to end the chronic disease crisis.

2:16

Justin Mares @jwmares 2d

Few understand just how often American hospitals sue their patients.

In Virginia alone, hospitals and other medical providers sued patients 1.15M times from 2010 to 2024. That's more than 1 in 4 debt collection suits in the state!

More than half of these lawsuits were brought by nonprofit hospitals (yes, the tax-exempt ones).

And hospitals received court orders to garnish their own workers' wages 4,100 times.

Not great!

Justin Mares @jwmares 4d

One thought from the election results is that local politics are subsumed by tribal affiliation. Everything is red or blue, everything is federal politics.

When voters have the chance to express thoughts on specific policies, more nuance comes through.

LindyMan Verified account @PaulSkallas 4d

People don't get it. Representative democracy and direct democracy are two separate systems.

Someone votes for a politician because of tribal affiliation, mood, passion, ideology. They are not an independent person.

Someone votes for a law differently. They evaluate it as an independent person. See how it affects them and their environment. And make a vote.

Two completely different pathways

View quoted post on X

Justin Mares @jwmares 5d

Charlie Munger has a quote I often think about: "Show me the incentive and I'll show you the outcome."

I've been thinking of Charlie's quote through the lens of drug prices.

As of this week, pharmacy middlemen (PBMs) will have to disclose the secret payments that shape your drug prices to the employers paying them.

PBMs are commonly in charge of which drugs your plan covers. They also negotiate with drug manufacturers for rebates, and can retain a percentage of the rebate.

See the game?

The drug with the highest rebate can beat the drug with the lowest total cost.

And since coinsurance is often based on list price, you end up paying more at the counter.

Then there's the copay claw-back. If your copay for a generic drug is $15, but the PBM has agreed to pay the pharmacy $5, the PBM claws back the excess $10.

It's not clear that money is ever reimbursed to the plan (or you).

Plain and simple, incentives.

The Labor Department just finalized a rule that will require PBMs to disclose all of this to large employers' health plans: rebates from drug manufacturers for each drug, the spread, and claw-backs. Employers can also audit them at least once per year.

It applies to plan years beginning on or after July 1, 2027.

Employers are finally being shown the incentive.

I suspect they'll now demand additional concessions, putting downward pressure on drug prices.

Justin Mares @jwmares Oct 30

Mark Cuban's Cost Plus Drugs is a good example of what actually drives change in healthcare costs. His company charges a flat 15% markup on more than 4000 drugs and showing everyone the price.

That's it. No new law, no new agency.

And his company has forced incumbents to change prices in a way decades of policy never did.

So much of our system only works because nobody can see the prices. Transparency is wildly underrated as health policy!

x.com/a16z/status/21…

a16z @a16z Oct 28

Mark Cuban scaled Cost Plus Drugs from about 100 generics to roughly 4,000 at a flat 15% markup, forcing incumbents to change prices in ways decades of policy never did.

He thinks AI could transform healthcare, but it won't fix opaque prices and broken incentives on its own.

Mark sits down with a16z's Julie Yoo and Erik Torenberg to discuss what he's learned building Cost Plus Drugs, why trust is its core product, and how greater transparency could put pressure on healthcare costs.

They also explore why drugs designed for your DNA could cost close to nothing, the football field-sized drug plant his team shrank into tractor trailer-sized pods, his plan to make generics in Dallas for less than he pays manufacturers in India, and why every company will either be great at AI or go out of business.

0:50 Cost Plus beat decades of policy
3:15 111 generics to 4,000 drugs
5:00 A drug plant shrunk to 5K sq ft
5:55 $20M drug factories in a trailer
8:10 Hospital deals with zero denials
9:50 Why health plans are rigged
14:05 1,335 pages no human can check
18:35 "Where are they f**king me over?"
22:45 Making drugs cheaper than India
26:50 Why you still need entry-level hires
31:45 Nonprofit hospitals must offer aid
35:55 DNA-matched drugs for near $0
39:30 Why AI will mean more doctors
48:00 Mark's plan: "bye bye insurers"
52:25 Why AI labs' ads are useless
56:35 Get good at AI or go out of business

YouTube: youtu.be/5UWDUD6qaM4

@mcuban @julesyoo @eriktorenberg

View quoted post on X