Florida probes CVS Health in latest crackdown on PBMs
Florida is the latest state to launch an investigation into the business practices of pharmacy benefit managers (PBMs), specifically in this case Caremark, part of CVS Health.
Announced Wednesday, state Attorney General James Uthmeier said a “civil investigative demand” has been sent to CVS, seeking to examine the scope of anticompetitive business practices the company may be engaged in, both in its role as a middleman in the distribution of pharmaceutical drugs and through its retail chain of pharmacy stores.
Uthmeier said his office is looking into whether or not CVS is effectively controlling the prices of prescription drugs by hindering the operations of independent drug stores by imposing “burdensome audits that claw back payments” and reimbursing its “affiliated stores more generously than independent pharmacies for identical prescriptions.”
Doing so would be illegal under state law, where the company is allowed to operate both a PBM and retail pharmacy stores. However, it is not allowed to squeeze out the competition by steering health plans and patients to CVS retail pharmacies through the use of tools, such as discounts and manufacturer rebates, that it doesn’t also honor when prescriptions are filled by competitors.
CVS operates roughly 800 pharmacy stores in the state, leaving the attorney general concerned about “self-preferencing and vertical integration” that could force mom-and-pop shops to close their doors.
“Florida families and seniors deserve access to affordable medication and real pharmacy choices—not a system rigged by one giant corporation that may favor its own stores and squeeze out competitors,” Uthmeier said in a statement. “This investigation will uncover the truth and protect fair competition for all Floridians.”
His office added that, if their concerns are true, the state could be left with “pharmacy deserts”—rural areas where there are no pharmacies at all, as they’ve been forced to go out of business.
Such issues make it challenging for patients living in those communities to access drugs and pharmacy services at all—to the potential benefit of CVS, whose pharmacies may become the nearest available option for many patients.
The announcement from Uthmeier’s office said that the three largest PBMs—Express Scripts, Optum Rx and Caremark—together control about 80% of all drug prescriptions in the country. Regulators have taken a particular interest in CVS because of its nationwide chain of some 9,000 retail pharmacies, in addition to its “dominant” PBM business.
“The Attorney General’s action today sends a clear and necessary message: the era of unchecked PBM abuse in Florida is over,” said incoming President of the Florida Pharmacy Association Aneesh Lakhani. “My patients deserve better. Florida deserves better. The system wasn’t broken, PBMs broke the system. We will not rest until they are held fully accountable.”
No official claims of wrongdoing have been levied and no civil lawsuit has been filed. For now, the company is only being investigated.
A nationwide crackdown
Other states have moved to take action against these types of vertically integrated business models, including Arkansas and Tennessee, which have passed laws barring PBMs from owning retail pharmacies in the state.
Those laws are being challenged in lawsuits filed by the “big three” PBMs.
At the same time, Virginia, New York, Oklahoma, Texas, and others, are considering similar legislation to curb potential abuses to the pharmaceutical drug supply chain.
The investigation by Florida will require CVS to hand over thousands of documents pertaining to reimbursement rates, pharmacy contracts, and more by July 28, 2026.
Chad is an award-winning writer and editor with over 15 years of experience working in media. He has a decade-long professional background in healthcare, working as a writer and in public relations.