Florida has become the latest state to intensify scrutiny of Pharmacy Benefit Managers (PBMs). In a significant development for the pharmacy industry, Florida Attorney General James Uthmeier has issued a Civil Investigative Demand (CID) to CVS Health Corporation and its PBM, CVS Caremark, seeking documents and testimony regarding alleged business practices that may have harmed competition, limited patient choice, and disadvantaged independent pharmacies.
While the investigation remains in its early stages and no findings of wrongdoing have been made, the Attorney General's action reflects a growing national trend of increased governmental oversight of PBMs and their business practices.
A Growing Focus on PBM Oversight
According to the Attorney General's announcement, the investigation seeks information regarding whether Caremark engaged in practices such as patient steering, differential reimbursement, restrictive contracting, burdensome audit practices, and other conduct that could reduce competition or place independent pharmacies at a competitive disadvantage. The Civil Investigative Demand requires the production of extensive documents and sworn testimony before the Attorney General determines whether additional action is appropriate.
Importantly, a Civil Investigative Demand is not a lawsuit and does not establish liability. Rather, it is an investigative tool used to gather information before deciding whether enforcement action is warranted. CVS Health has publicly stated that it intends to cooperate with the investigation while disputing the underlying allegations.
Why This Matters to Independent Pharmacies
For many independent pharmacies, the issues identified in Florida's investigation are familiar. Across the country, pharmacy owners have long expressed concerns regarding PBM reimbursement methodologies, network participation requirements, audit and recoupment practices, patient steering, and the competitive effects of vertically integrated healthcare organizations.
Although the outcome of Florida's investigation remains unknown, it signals that state regulators are increasingly willing to examine whether PBM practices affect patient access, competition, and the long-term viability of community pharmacies. Rather than focusing solely on legislative reform, regulators are now utilizing investigative authority to evaluate whether PBMs’ existing business practices comply with state law and public policy.
Independent Pharmacies Should Remain Proactive
This investigation also serves as an important reminder that pharmacies should never assume that a PBM audit, credentialing dispute, or network termination is merely a contractual disagreement. PBM findings often become part of a pharmacy's broader compliance history and, in some cases, may be reviewed by government agencies or licensing authorities during future investigations.
Responding promptly and comprehensively to PBM audits and appeals is critical. A well-supported response not only preserves the opportunity to remain in-network but also creates a documented record demonstrating the pharmacy's compliance with applicable laws, regulations, contractual obligations, and industry standards. Early legal intervention can frequently resolve issues before they escalate into larger regulatory or enforcement matters.
The PBM Landscape Continues to Evolve
Florida's investigation is part of a broader national movement toward increased examination of PBM operations. Over the past several years, Congress, CMS, the Federal Trade Commission, state legislatures, and numerous state attorneys general have all increased scrutiny of PBMs and vertically integrated healthcare organizations. Regardless of the outcome of this particular investigation, independent pharmacies should expect continued regulatory attention to issues involving network participation, reimbursement practices, audit procedures, and patient access.
How Health Law Alliance Can Help
Health Law Alliance represents independent pharmacies nationwide in matters involving PBM audits, PBM credentialing denials, network terminations, recoupment actions, CMS audits, and UPIC investigations, and other healthcare regulatory and enforcement matters.
If you are an independent pharmacy owner facing a PBM audit, PBM credentialing denial, PBM network termination, or another government or payer investigation, our attorneys can help protect your business, preserve your network participation, and develop a strategic response tailored to your circumstances. Contact Health Law Alliance today for a free consultation to discuss your pharmacy's options before critical appeal deadlines expire.
