Florida's insurance regulator has fined pharmacy benefit managers — the middlemen who run prescription drug benefits for health plans — more than $12.66 million in total, after state examinations found violations in how their contracts deal with pharmacies and patients. Insurance Commissioner Mike Yaworsky announced the penalties in Tallahassee on Monday, November 9.

Source: Florida Office of Insurance Regulation press release (via Alachua Chronicle)

The penalties are the culmination of market conduct examinations by the Office of Insurance Regulation (OIR) into the business and affairs of pharmacy benefit managers, known as PBMs, doing business in Florida. According to OIR, the examination reports cite violations relating to fair pricing models, network adequacy and fair access, pharmacy remittances, and the prohibition on unilateral changes to pharmacy contracts.

"We 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," Commissioner Yaworsky said in the announcement. "I want to be clear to PBMs and the Associations they hide behind — the laws of Florida will be adhered to, and you will be held accountable."

What a PBM does, and why Florida is policing it

A pharmacy benefit manager is a company that contracts to administer prescription drug benefits on behalf of a health plan or program. PBMs decide which medicines are covered, negotiate prices and rebates with drugmakers, and set how much pharmacies are paid when they dispense a prescription. Because those decisions sit between patients, pharmacies, insurers and drug companies, regulators say small contract abuses can quietly raise costs at the pharmacy counter.

Florida's enforcement powers come from the Prescription Drug Reform Act, which Governor Ron DeSantis championed and signed in May 2023 to add consumer protection and regulatory transparency for PBMs operating in the state. Under the law, OIR has the authority to examine the business and affairs of each PBM every two years. Florida Statutes section 626.8828 sets an administrative fine of $5,000 for each violation, with every instance against each individual pharmacy or plan counting as a separate violation and no cap on the aggregate fines — the mechanism by which the penalties announced Monday grew past $12.66 million.

Source: Florida Statutes 626.8828 (Florida House)

Pushback, unpaid bills and corrective action

OIR says that as a result of the examinations, many PBMs have taken, or are in the process of taking, corrective action. But the regulator also says several PBMs are actively pushing back against its findings and penalties and are pursuing litigation, and that completion of some examinations has been delayed because certain PBMs are not cooperating with the statutory examinations. In some cases, OIR says, examiner invoices have not been paid by the examined PBM since January 2025. The office says it continues to evaluate each of those cases to determine the appropriate enforcement action. Under the statute, failure to pay examination expenses or fines is grounds for denial, suspension or revocation of a PBM's certificate of authority to operate.

The penalties land on top of a wider Florida fight over PBM power. In August, the Florida Attorney General's office sued Prime Therapeutics and Express Scripts in Polk County, alleging the two rival PBMs agreed to fix the reimbursement rates paid to Florida pharmacies — allegations the state's complaint says cost pharmacies and patients dearly, and which the companies have the right to contest in court. Nationally, Bloomberg Law has reported that Florida's PBM audit programme has also drawn industry objections over the patient data the state demands during examinations, a dispute that tests how far state regulators can go.

What this means for Florida readers

For anyone in Florida who fills a prescription through a health plan — including the state's large Punjabi and wider South Asian communities in cities such as Orlando, Tampa, Jacksonville and South Florida — the practical stakes are the price at the counter, whether a local pharmacy stays in network, and whether rebates negotiated in their name actually lower what they pay. OIR's position is that fair pricing models, adequate networks and prompt remittances to pharmacies are exactly what keep independent pharmacies open and drug costs honest.

What happens next

OIR examiners are still completing additional examinations of other PBM contracts, and the office must report examination results each year by January 15 to the Governor, the President of the Senate and the Speaker of the House. PBMs that are contesting findings will fight their cases in court or through the administrative process, while those that do not pay fines or examination costs risk losing their authority to operate in Florida. Awaaz Punjab will follow the January report and any court rulings that trim or uphold Monday's penalties.