Florida Attorney General Opens Investigation Into PBM And Pharmacy Parent Company Over Alleged Anticompetitive Pharmacy Practices

On June 23, 2026, Florida Attorney General James Uthmeier issued a civil investigative demand (CID) to CVS Health Corporation, the parent company of both the Caremark pharmacy benefit manager (PBM) and hundreds of CVS retail pharmacies in Florida, opening a civil investigation into alleged anticompetitive and unfair pharmacy practices. The investigation is the latest in a wave of state and federal actions targeting the vertically integrated business models of the nation's largest PBMs.

Key Takeaways

• Caremark (one of three PBMs administering approximately 80 percent of U.S. prescriptions) and CVS's roughly 800 Florida pharmacies are both owned by CVS Health, raising concerns that CVS may have the ability and incentive to favor its own stores over independent competitors.
• Attorney General Uthmeier has not yet alleged any violations of Florida law; rather, the CID is a fact-gathering tool that may or may not lead to enforcement action.
• The probe follows the Federal Trade Commission’s (FTC) insulin-pricing litigation against the "Big Three" PBMs—Caremark, Express Scripts and Optum Rx—which has produced settlements with Express Scripts on February 4, 2026, and Caremark on July 14, 2026, requiring sweeping reforms to rebate and formulary practices.

Background on the Florida Investigation

Attorney General Uthmeier announced the CID at a Miami press conference, citing complaints from independent pharmacies about pressure tactics by CVS and Caremark. He framed the investigation as necessary to give Floridians access to affordable medication and genuine pharmacy choice, rather than a system he described as favoring one dominant corporation. The Agency for Health Care Administration—the chief health policy and planning body for the state of Florida, responsible for administering the state’s Medicaid program and regulating health care facilities—and the Florida Pharmacy Association both voiced support for the investigation.

The CID seeks documents and information on whether Caremark steers patients to CVS-owned pharmacies, reimburses CVS or other affiliated pharmacies more generously than independents for identical prescriptions, uses audits to clawback payments made to pharmacies and enforces contract terms that burden smaller pharmacies. State officials say such practices may be contributing to pharmacy closures and "pharmacy deserts" in rural and underserved communities. The CID demands documents and sworn testimony by July 28, 2026. Notably, days after the announcement, Uthmeier said an independent pharmacist who appeared at the press conference received a late-night audit from CVS, which he suggested looked like retaliation for speaking out publicly. He said his office would address the allegation, suggesting that the attorney general's office may scrutinize how CVS treats cooperating witnesses as the investigation proceeds.

CVS has said it will cooperate with the investigation, but pushed back on the underlying theory of harm, arguing that drug manufacturers alone are responsible for setting prescription drug prices and that PBMs are being unfairly blamed for pricing dynamics they do not control. The company also maintained that independent pharmacies remain an important part of the Caremark network.

Broader Regulatory Context

Florida's inquiry arrives amid intensifying state and federal scrutiny of PBM practices.

The FTC conducted a study of PBM practices under Section 6(b) of the FTC Act, finding similar concerns as those being investigated by the CID in two interim reports issued in 2024 and 2025. The FTC also sued Caremark, Express Scripts and Optum Rx in 2024 over rebate-driven formulary practices alleged to have inflated insulin list prices at patients' expense. That case has produced settlements with Express Scripts (February 2026) and Caremark (July 2026) requiring both PBMs to delink fees from list prices, increase transparency and offer community pharmacies better reimbursement terms. Optum Rx remains in active settlement talks with the FTC. The Caremark settlement also addressed concerns, raised in a January 2026 House Judiciary Committee report, that Caremark interfered with patient access to "hub pharmacy" services, a self-preferencing concern that echoes Florida's inquiry.

The Centers for Medicare and Medicaid Services (CMS) recently issued a proposed rule that would establish a permanent regulatory framework for the Medicare Drug Price Negotiation Program created by the Inflation Reduction Act, with a goal of providing pharmacies with greater reimbursement consistency.

The recently enacted Consolidated Appropriations Act of 2026 requires that CMS assess whether reimbursement and fee structures are set at levels that effectively discourage or preclude participation, particularly for independent and community pharmacies who want to service Medicare Part D beneficiaries.

And state attorneys general have ramped up antitrust and consumer protection enforcement against PBMs and other areas of healthcare, and in some instances have been more aggressive than federal regulators. Uthmeier's CID against CVS is consistent with his office’s use of subpoenas to investigate major corporations, including a the recently announced investigation of potassium bromate in products sold in Florida’s food supply chain.

Conclusion

Florida’s investigation into practices of CVS Health could have significant impacts for Florida-based independent pharmacies as well as the broader PBM enforcement landscape.

• Reimbursement disparities between affiliated and independent pharmacies, patient steering, and audit and clawback practices remain recurring enforcement targets and warrant compliance review.
• The investigation may provide a factual record that could be relied upon by the Florida Legislature to introduce and/or pass additional legislation regulating PBMs, addressing issues such as reimbursement transparency, pharmacy steering restrictions and stronger protections for independent pharmacies.
• Companies responding to a CID or subpoena should ensure that routine business conduct, such as pharmacy audits, cannot be perceived as retaliation against cooperating witnesses or complainants.
• The FTC's Express Scripts and Caremark settlements may preview the types of remedies Florida or other states could seek if their investigations lead to enforcement.
• Florida joins a growing number of states examining vertically integrated PBMs. Findings in Florida could encourage similar investigations in other states of major PBMs.

For More Information

If you have any questions about this Alert, please contact Christopher H. Casey, Jonathan L. Swichar, Bradley A. Wasser, Kirk Williams McLeod, any of the attorneys in our Antitrust and Competition Group, any of the attorneys in our Pharmacy Litigation Group, any of the attorneys in our State Attorneys General Group or the attorney in the firm with whom you are regularly in contact.