Florida Attorney General James Uthmeier issued a Civil Investigative Demand on June 23, 2026, to CVS Health Corporation, the parent company of both the Caremark pharmacy benefit manager (PBM) and hundreds of CVS retail pharmacies operating throughout Florida. The action opens a formal investigation into whether CVS Health’s dual ownership of a dominant PBM and a vast retail pharmacy network has allowed the company to disadvantage independent pharmacies and drive up costs for Florida families and seniors.
Florida’s investigation is another step in addressing alleged PBM abuses and is a positive signal for independent pharmacies as it highlights the continued regulatory attention to reimbursement practices, network contracting terms, and audit conduct that may harm pharmacies.
Florida’s Investigation Into CVS Health and Caremark
Caremark is one of the three largest PBMs in the country, and together with its two largest competitors, Express Scripts and Optum Rx, these three PBMs controls roughly 80 percent of prescriptions filled in the United States. PBMs like Caremark occupy a powerful position in the drug supply chain. Caremark determines which medications are covered, sets reimbursement rates for pharmacies, and influences where patients are able to fill their prescriptions. CVS Health’s structure, pairing Caremark with more than 9,000 pharmacies nationwide, including approximately 800 in Florida, has drawn scrutiny from regulators concerned about patient steering/self-preferencing and vertical integration in the PBM industry.
Scope of the Civil Investigative Demand
The Demand directs CVS Health and Caremark to produce thousands of documents and to provide sworn testimony addressing a broad range of business practices, including:
- whether Caremark steers patients toward CVS-owned pharmacy locations over independent competitors;
- whether CVS-affiliated pharmacies are reimbursed more favorably than independent pharmacies for identical prescriptions;
- the use of pharmacy audits that result in recoupment of prior payments;
- contractual terms imposed on network pharmacies;
- rebate practices; and
- CVS Health’s expansion plans within the state.
Compliance was required by July 28, 2026, and no findings have been published to date. According to the Attorney General’s office, the practices under review may have contributed to pharmacy closures and the emergence of “pharmacy deserts” in parts of Florida, leaving patients, particularly seniors, with fewer options and higher out-of-pocket costs.
Part of a Broader National Trend
Florida’s investigation into CVS Health and Caremark is consistent with a wave of state-level enforcement actions and legislation targeting vertically integrated PBMs. Attorneys general in states including Oklahoma and Louisiana have pursued litigation against Caremark over similar allegations involving below-cost reimbursement, patient steering, and self-preferencing arrangements benefiting CVS-owned pharmacies. State legislators in both Tennessee and Arkansas have passed legislation prohibiting PBMs from directly owning or operating pharmacies. At the federal level, the Federal Trade Commission and the House Judiciary Committee have likewise scrutinized the largest PBMs’ vertical integration with retail pharmacy and specialty pharmacy operations.
Florida’s investigation signals that state regulators continue to view PBM vertical integration, and the incentives it creates to disadvantage independent and community pharmacies, as a significant and unresolved antitrust concern. For independent pharmacies located or operating in Florida, the investigation is an encouraging sign that regulators continue to examine reimbursement practices, network contracting terms, patient steering, and PBM audit conduct. As the investigation progresses, it could also lead to additional legislation or regulatory action addressing alleged anticompetitive PBM practices in the state.
How Frier Levitt Can Help
Frier Levitt regularly represents independent and community pharmacies in disputes with PBMs, including matters involving reimbursement below acquisition cost, burdensome or retaliatory audits, restrictive network contracts, and improper termination from PBM networks. Frier Levitt also regularly contributes to legislative and regulatory efforts to draft bills and regulations to curb PBM abuses. If your pharmacy has experienced reimbursement disparities, burdensome audit practices, or contract terms that raise concerns similar to those described in Florida’s investigation, Frier Levitt’s attorneys are available to discuss your options, including audit defense, contract review, and regulatory advocacy.
Senior Associate
