Florida launches investigation into CVS Caremark over pharmacy competition concerns

ORLANDO, Fla. - Florida Attorney General James Uthmeier has launched an investigation into CVS Health and its pharmacy benefit manager (PBM), Caremark, amid concerns that the company may be using its market power to disadvantage independent pharmacies and limit consumer choice.

The probe, announced Tuesday, centers on whether CVS Health's ownership of both one of the nation's largest PBMs and hundreds of retail pharmacies in Florida creates unfair competitive advantages that could affect prescription drug access and pricing.

What we know:

Florida Attorney General James Uthmeier is seeking documents and sworn testimony related to the operations of CVS Caremark and CVS retail pharmacies in Florida.

The investigation focuses on allegations that Caremark may steer patients toward CVS-owned pharmacies, reimburse affiliated stores at higher rates than independent pharmacies for the same prescriptions, impose audits that result in payment clawbacks, and use restrictive contracts that place financial pressure on smaller competitors.

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As part of the investigation, CVS will be required to produce thousands of records covering reimbursement practices, pharmacy contracts, audits, rebates, patient steering, treatment of affiliated versus independent pharmacies and future expansion plans. CVS must comply by July 28, 2026, Uthmeier said.

The state noted that Caremark is among the three largest pharmacy benefit managers in the United States, a group that collectively processes about 80% of all prescriptions nationwide. CVS Health also operates more than 9,000 pharmacies across the country, including roughly 800 locations in Florida.

What we don't know:

State officials have not alleged specific violations of Florida law or announced any enforcement action against CVS Health at this stage.

It also remains unclear whether the investigation will find evidence that CVS Caremark reimbursed affiliated pharmacies differently than independent competitors, improperly steered patients, or engaged in anti-competitive conduct.

The backstory:

Pharmacy benefit managers serve as intermediaries between insurers, drug manufacturers and pharmacies. They negotiate rebates with drugmakers, determine which medications are covered by health plans, establish reimbursement rates for pharmacies and manage prescription drug networks.

RELATED: Three major hospital systems accuse CVS of secretly siphoning hundreds of millions in drug savings

In recent years, PBMs have faced growing scrutiny from lawmakers, independent pharmacists and consumer advocates who argue that consolidation within the industry has given a small number of companies significant influence over prescription drug access and pricing.

Critics contend that vertically integrated companies — those that own both PBMs and pharmacies — may have incentives to favor their own retail operations. PBMs, however, have argued that they help lower prescription costs by negotiating discounts and rebates on behalf of health plans and consumers.

Big picture view:

The Florida investigation reflects a broader national debate over the role of pharmacy benefit managers in the health care system and whether increased oversight is needed,'

Independent pharmacies across the country have warned that reimbursement rates and administrative requirements imposed by PBMs contribute to store closures, particularly in rural and underserved communities. 

For Florida, the outcome of the investigation could have implications for hundreds of pharmacies, prescription drug access and competition within the state's health care marketplace.

What they're saying:

Attorney General James Uthmeier framed the investigation as an effort to protect consumers and independent pharmacies.

"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. "This investigation will uncover the truth and protect fair competition for all Floridians."

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Agency for Health Care Administration Secretary Shevaun Harris said the inquiry is intended to increase accountability within the PBM industry.

"Floridians expect a health care system that works for them, not against them," Harris said. "The Attorney General's action is an important step toward that future, and AHCA is proud to stand alongside this effort to ensure accountability of PBMs."

Florida Pharmacy Association incoming President Aneesh Lakhani praised the investigation and criticized PBM business practices.

"The Attorney General's action today sends a clear and necessary message: the era of unchecked PBM abuse in Florida is over," Lakhani said. "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."

The other side:

CVS Health said it plans to cooperate with the state while disputing claims that PBMs are responsible for high prescription drug costs. It released the following statement:

"CVS Health works every day to put medicine within reach in Florida and across the United States. Drugmakers alone set the price of prescription drugs, and blaming a PBM for high drug prices is like blaming an umbrella for the rain.

"Independent pharmacies remain vital to CVS Caremark’s networks, and we collaborate with them to ensure all members have convenient access to the care they need. 

"We welcome the opportunity to work with policymakers to set the record straight around these market dynamics, and more importantly, to improve consumer experience and affordability."

 

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