Florida Attorney General James Uthmeier has opened an investigation into CVS Health Corporation and its pharmacy benefit manager (PBM), Caremark, over alleged anticompetitive conduct affecting pharmacies and patients in Florida.
As laid out in a press release issued by the Florida Attorney General’s Office, CVS Health owns both Caremark—one of the nation’s largest PBMs—and hundreds of CVS retail pharmacies in Florida. The investigation will examine whether CVS/Caremark has used that vertically integrated structure to steer patients toward CVS-affiliated pharmacies, reimburse its own pharmacies more favorably than independent pharmacies, impose burdensome audits or clawbacks on smaller pharmacies, or enforce contractual terms that limit competition and patient choice. The Attorney General issued a Civil Investigative Demand (CID) seeking documents and sworn testimony regarding reimbursement rates, pharmacy contracts, patient steering, audits, rebates, differential treatment of CVS-affiliated and independent pharmacies, and expansion plans. CVS has denied any wrongdoing.
The Florida investigation is part of a broader national trend. PBMs have come under increasing scrutiny from state attorneys general, legislatures, Congress, and federal regulators over their role in prescription drug pricing, pharmacy reimbursement, formulary placement, rebate arrangements, and relationships with affiliated pharmacies. In July 2024, te Federal Trade Commission (FTC) issued a report finding that the three largest PBMs process nearly 80% of prescriptions dispensed by U.S. pharmacies and are vertically integrated with major health insurers, specialty pharmacies, and retail pharmacy operations. The FTC has also brought a civil action against major PBMs, including Caremark, alleging that certain rebate practices artificially inflated insulin list prices.
GWB represents pharmacies in connection with various issues, including PBM audits, investigations, and reimbursement disputes. If you need assistance with such a matter, please contact us today.
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