A Fort Worth-based pharmacy is drawing viral attention after calling out major contradictions in the prices of common cancer medications, highlighting how pharmacy benefit managers (PBMs) may be contributing to inflated prices for Medicare patients.

Forest Park Pharmacy recently shared on social media an example of a cancer prescription in which the pharmacy itself acquires the drug for $7 per month’s supply and sells it for $17 cash. At the same time, Medicare reimburses around $2,400 for the same medication.

“We get people looking for this everyday. PBM-owned “Specialty” pharmacies haven’t stopped exploiting it,” Forest Park Pharmacy posted on X.

In an interview with The Dallas Express, Brad Hart, co-owner of Forest Park Pharmacy, explained some of the weirdness going on in the background of the pricing mechanics – specifically connected to PBMs.

Hart attributed some of the imbalanced Medicare reimbursement rates to PBMs, which act as middlemen between pharmacies, insurers, and drug manufacturers.

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“We just buy the medication from wholesalers, and then we do, we have 15% plus $10 – so for that particular medication in that video – for a month supply that that comes out from our wholesalers for seven bucks, after all of our additions $17 is the total price, but because of all the crazy reasons with insurance Medicare is paying that $2,400 price,” Hart said.

“The Medicare pricing comes because they use a middleman called the PBM, and those guys play all kinds of crazy games with the prices. Usually what it is – is there is an insurance metric price called the AWP that they use to set their prices. And that AWP price is just nonsense… so they act like they’re saving by bringing it down to 2400 when, in reality, the price that we buy it for is, you know, pennies,” Hart explained.

PBMs are known for managing prescription drug benefits for health plans, including Medicare Part D, by negotiating prices and rebates with manufacturers and establishing pharmacy networks.

Supporters of the PBM system could make a stretching argument that they help lower net drug costs through these negotiations and provide clinical oversight to ensure appropriate medication use. However, growing vocal critics, including independent pharmacies, argue that PBM practices lack transparency, encourage higher list prices to maximize rebates, and result in overpayments that benefit the “big pharma profiteers” rather than the actual patients.

The three largest PBMs: CVS Caremark, Express Scripts, and OptumRx control about 80% of the market, according to DrugChannels.Net, which could ramp up more concerns in the future about their influence on pricing and some of these huge price gaps.

Data from a study by the Jama Network show additional examples of the big pricing gaps described by Hart.

For generic Imatinib (a medication used primarily to treat chronic myeloid leukemia and other cancers), pharmacies’ costs can be as low as $4.20 per unit. Still, Medicare Part D reimbursements have averaged around $3,780 for a 30-day supply in some cases, representing a markup of over 30 times the cost.

Even with generics available since 2016, Medicare beneficiaries may face out-of-pocket costs ranging from $80 to $400 per fill, depending on their plan, according to the National Library of Medicine.

Hart also said that these pricing discrepancies are not isolated to just a few medications.

“There’s hundreds of medications like that,” he said. “I looked through the top 200, and we weren’t cheaper on 100% of medications, but overall we were about 30% cheaper. So it’s a ton of medications, and, like I said, that’s with nothing. I don’t have special negotiating power. I don’t have special buying power. That’s just the price the medications cost, and they’re just overpaying them because the middleman has the power to extract that from us.”

Forest Park Pharmacy has consistently raised awareness about these issues through its social media posts on X.

In a March 2025 post, the pharmacy questioned why Medicare pays a 2,500% markup on a generic medication, echoing the current example.

Another from April 2025 highlighted $160 million in wasted spending, again likely due to “middlemen” in the industry dictating prices.

More recently, in December 2025, their account also criticized PBM-imposed rules such as therapeutic class caps, which they say penalize independent pharmacies and their patients.

For patients seeking to avoid overpaying for their meds, Hart recommended using tools like Forest Park Pharmacy’s online price checker.

“If anybody out there is looking to make sure that they don’t get stuck overpaying, they need to use our price checker,” he said. “Even if they don’t use our pharmacy, our price checker is a tool that can make sure that they’re not overpaying when they go to the pharmacy.”