Florida Regulators Hit 13 Pharmacy Benefit Managers With $12.66 Million in Penalties Under 2023 Drug Pricing Law

Florida's Office of Insurance Regulation has issued more than $12.66 million in penalties against 13 pharmacy benefit managers, the companies that sit between insurers, drugmakers and pharmacies, after examinations found their contracts lacked protections required by the state's 2023 Prescription Drug Reform Act, Insurance Commissioner Mike Yaworsky announced this week.

The action, reported by Florida Politics on Nov. 10, is the largest round of enforcement yet under the law Gov. Ron DeSantis signed in May 2023 to rein in drug pricing middlemen. Six companies drew penalties of $1 million or more, and several are fighting the findings in court.

Who was penalized and how much

The largest penalty went to Employee Health Insurance Management, at $2.415 million, according to the agency's figures as reported by Florida Politics. Five other companies were assessed at least $1 million each.

The six largest penalties break down this way:

Those six account for about $11.56 million of the total. The remaining seven companies, which together account for roughly $1.1 million, are Drexi, PerformRx, MC-21 Healthcare, Benecard Services, CarelonRx, Prime Therapeutics Management and Prime Therapeutics. Individual amounts for those seven were not included in the published reports.

CarelonRx is the pharmacy benefit arm of insurer Elevance Health, and Prime Therapeutics is owned by a group of Blue Cross and Blue Shield plans. Most of the larger penalties, however, landed on smaller and midsize PBMs rather than the three national giants that dominate the market.

What the law requires

Pharmacy benefit managers negotiate drug prices on behalf of health plans, process prescription claims and decide which drugs appear on a plan's formulary, the list of covered medications. Critics, including independent pharmacists, have long argued the companies keep a share of manufacturer rebates and squeeze pharmacy reimbursements in ways patients never see.

Florida's Prescription Drug Reform Act, passed unanimously by the Legislature as SB 1550 and in effect since July 1, 2023, put PBMs under the Office of Insurance Regulation's oversight and required them to hold a state certificate of authority. According to the agency's summary as reported by Florida Politics, the law requires PBMs to:

• Use pass-through pricing and send all drugmaker rebates to the health plans they serve.
• Maintain adequate pharmacy networks.
• Give patients 60 days of continued access, at the same price, when certain drugs are dropped from a formulary.
• Refrain from financial clawbacks against pharmacies and from unilateral changes to pharmacy contracts.

The law also directs the office to examine every registered PBM at least once every two years.

Why the fines added up so quickly

The penalty math is set in statute. Section 626.8828 of the Florida Statutes directs the office to impose an administrative fine of $5,000 for each violation of the law's core contracting and network provisions. Each instance involving each individual pharmacy or prescription benefits plan counts as a separate violation, and the statute says there is no limit on aggregate fines.

OIR counted hundreds of missing contract terms as separate violations, Florida Politics reported. That approach is what pushed several penalties past $2 million.

The examination reports generally cite required protections that were absent from written contracts, rather than documented cases in which a PBM actually kept rebates or clawed back money from a pharmacy. Some companies agreed to add the missing language. Others argued that they complied in practice, that the protections appeared in other documents, or that Florida law did not apply to the arrangements cited.

What the commissioner said

Yaworsky previewed the crackdown at the Florida Chamber's Future of Florida Forum, where he called PBMs "hidden actors in the insurance space" and said OIR would "shed a great deal of light on that industry and take action wherever appropriate," according to Florida Politics.

In announcing the penalties, the commissioner said Florida must "demand transparency and accountability for all Pharmacy Benefit Managers in Florida to ensure companies cannot hide revenue, retain rebates instead of passing savings to consumers or raise costs for patients who may rely heavily on critical prescriptions."

He also addressed the industry's trade groups directly, saying the laws of Florida "will be adhered to, and you will be held accountable."

Pushback, litigation and unpaid bills

OIR said many of the penalized companies have taken corrective action or started to. Several, however, are contesting the agency's findings or penalties in court, according to the agency's release, which did not say which firms are involved in that litigation.

The agency also accused certain PBMs of failing to cooperate and of delaying some reviews. In some cases, it said, examiner invoices have gone unpaid since January 2025. Under the same statute, failure to pay examination costs or fines can lead the office to deny, suspend or revoke a PBM's certificate of authority. OIR said it is evaluating whether to take further enforcement action.

The friction is not new. In a summary report on its PBM examinations released in January 2026, OIR described exams it said had been impeded, disputes tied up in litigation and nearly $500,000 in unpaid regulatory invoices, according to coverage by The Capitolist at the time.

What it means for Floridians

For patients, the penalties do not translate into refunds or lower copays on their own. By statute, fine proceeds are deposited into the state's General Revenue Fund, and the violations cited were mostly about contract language rather than proven overcharges.

The bigger effect may come from the contract changes. If PBMs operating in Florida rewrite their agreements to spell out rebate pass-through, formulary transition periods and limits on clawbacks, pharmacies and health plans gain enforceable terms they can point to in disputes. Pharmacy groups, including the National Association of Chain Drug Stores, praised the law when it was enacted.

Florida is also one of several states stepping up PBM enforcement. Attorney General James Uthmeier separately opened an investigation this year into CVS Health's Caremark unit, according to HealthExec, and other states including Tennessee and West Virginia have taken their own actions against PBMs.

What's next

Additional examinations are underway, OIR said, so more penalties are possible as the agency works through the rest of the registered PBMs. The court challenges will determine whether the per-contract counting method holds up.

Lawmakers will also have a say. The Legislature convenes for its 2027 session in the spring, and PBM oversight has been on the agenda since the January examination report raised questions about cooperation and unpaid bills. Any move to give OIR more leverage over companies that stall examinations would likely surface in bills filed ahead of that session.