Florida's attorney general has opened an antitrust investigation into CVS Health, the parent of pharmacy benefit manager Caremark, alleging the company may favor its own stores and pressure independent pharmacies in the state.
Attorney General James Uthmeier issued a civil investigative demand to CVS Health — a legal tool that compels a company to hand over documents and sworn testimony. The demand requires CVS to produce records by July 28 covering reimbursement rates, pharmacy contracts, patient steering, audits, rebates and expansion plans.
What the probe alleges
Investigators are examining whether CVS and Caremark direct patients toward CVS-owned retail locations, reimburse affiliated stores more generously than independents for identical prescriptions, impose burdensome audits that claw back payments, and enforce restrictive contracts that strain smaller competitors, Fox 13 Tampa Bay reported. Officials say such practices may contribute to pharmacy closures and "pharmacy deserts," leaving some communities with fewer options.
"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 in a statement. CVS operates roughly 800 pharmacies in Florida, part of more than 9,000 nationwide.
How a PBM fits in
A pharmacy benefit manager, or PBM, is a middleman that administers prescription-drug benefits for insurers and employers. PBMs decide which drugs a plan covers, negotiate rebates with drugmakers, and set how much pharmacies are paid. The three largest PBMs, Caremark among them, process roughly 80% of U.S. prescriptions.
CVS Health is unusual because it is vertically integrated — it owns several links of the same supply chain: the PBM (Caremark), a large insurer (Aetna) and the retail pharmacies that fill prescriptions. Critics argue that structure creates an incentive for "self-preferencing" or "steering" — directing patients and favorable terms toward a company's own outlets rather than competing pharmacies. Such conduct can be anticompetitive if it disadvantages rivals through market power rather than on price or service.
CVS response
CVS rejected the premise that PBMs drive up costs. "Drugmakers alone set the price of prescription drugs, and blaming a PBM for high drug prices is like blaming an umbrella for the rain," the company said, adding that it will cooperate with investigators and that independent pharmacies remain vital to its networks. The Florida demand is an investigative step, not a finding of wrongdoing or a lawsuit; no charges have been filed.
Broader scrutiny
The inquiry adds to mounting regulatory pressure on PBMs and vertically integrated health-care companies. The Federal Trade Commission has pursued its own investigation of the largest PBMs, and a federal court in 2025 ordered Caremark to comply with that probe, the National Community Pharmacists Association noted. With states and federal regulators both circling, the case is part of a widening test of whether the consolidation that built today's health-care giants has tipped into anticompetitive conduct.
