Florida fines 13 drug middlemen $12.7 million under its 2023 drug law

Yaworsky fines the middlemen

Florida Insurance Commissioner Mike Yaworsky announced about $12.7 million in fines Nov. 9 on 13 drug middlemen that run prescription benefits for health plans. Most findings were terms the state's 2023 law requires that were left out of written contracts, not proven cases of keeping rebates, Florida Politics reported.

Why it matters: The three biggest middlemen, CVS Caremark, Express Scripts and OptumRx, control about 80% of U.S. prescriptions, Healthcare Dive reports, and none is on Florida's list. These firms bargain over drug prices for insurers and decide which drugs a plan covers, so they stand between your health plan and your pills. By law, the fines go to the state's general fund.

Yaworsky said the state must make sure the companies "cannot hide revenue." He told them: "you will be held accountable."

Six firms drew most of the money

The state's penalty table lists 13 entries that add up to exactly $12.66 million, by our arithmetic. Six firms drew fines of $1 million or more, Florida Politics reported.

Employee Health Insurance Management drew the largest, $2.415 million. Scrip World drew $2.23 million, Right Rx FL $2.115 million and ProAct $1.845 million. Capital Rx drew $1.59 million and Slate Rx $1.36 million. Those six come to about $11.6 million, or 91% of the total, by our arithmetic.

The other seven entries are smaller. Drexi drew $355,000, PerformRx $335,000 and MC-21 Healthcare $310,000. Benecard Services drew $60,000, CarelonRx $20,000, Prime Therapeutics Management $20,000 and Prime Therapeutics $5,000.

Two of the 13 entries are Prime Therapeutics units, so the list names 12 companies. Prime Therapeutics is one of the six largest benefit managers in the country, the Federal Trade Commission says. Its two units drew $25,000 in all.

What the exams found

The fines came out of state exams of each company's business, the Office of Insurance Regulation said. The exam reports cite violations of rules on fair pricing, pharmacy networks and fair access, payments to pharmacies, and the ban on changing pharmacy contracts without the pharmacy's agreement. They turned up in contracts with health plans and in contracts with pharmacies.

Most of the reports cite required protections left out of written contracts, Florida Politics reported. They generally do not document a company keeping rebates or clawing back pharmacy payments. The office counted hundreds of missing contract terms as separate violations.

State law sets a $5,000 fine for each violation. Each case against each pharmacy or plan counts as a separate violation, and the law sets no cap on the total. The money goes to the state's General Revenue Fund.

The law behind the exams

Gov. Ron DeSantis signed the Prescription Drug Reform Act in May 2023, the office said. It lets the office examine each benefit manager's business every two years. The law requires the middlemen to pass drug prices through to plans and to send all drugmaker rebates to the plans, Florida Politics reported. It also bars clawbacks and one-sided changes to pharmacy contracts.

Yaworsky, the insurance commissioner since March 2023, had previewed the push at the Future of Florida Forum. He called the companies "hidden actors in the insurance space" and promised to "shed a great deal of light on that industry and take action wherever appropriate," Florida Politics reported.

The three biggest are not on the list

Neither the state's penalty table nor Florida Politics' roster of all 13 includes CVS Caremark, Express Scripts or OptumRx. Neither source says why, and we found no record that explains it.

Those three control about 80% of U.S. prescriptions, Healthcare Dive reported. The Federal Trade Commission put the top three at nearly 80% of the roughly 6.6 billion prescriptions U.S. pharmacies filled in 2023, and the top six at more than 90%.

A separate state probe of CVS

In June, Attorney General James Uthmeier sought documents and sworn testimony from CVS about Caremark and its Florida pharmacies, FOX 13 reported on June 23. The probe asks whether CVS steers patients to its own pharmacies and pays its own stores more for the same prescriptions, Healthcare Dive reported. CVS runs roughly 800 stores in Florida, FOX 13 reported.

CVS said it would work with the attorney general and that "Drugmakers alone set the price of prescription drugs." That probe is separate from the insurance office's fines.

Pushback and unpaid bills

Many of the companies have fixed or are fixing the problems, the office said. Several are fighting its findings or fines and going to court. The release does not name them, Florida Politics noted.

Some exams are delayed because some companies are not cooperating, the office said. In some cases a company has not paid the state's exam invoices since January 2025, it said, a line that repeats its January report. It named no company and is weighing what action to take. Its examiners are working on more exams.

Their side

Some companies agreed to add the required language, Florida Politics reported. Others argued they complied in practice, had the protections in other documents or were not subject to Florida law in the cases cited. We found no statement from a fined company or its trade group.

The industry's trade groups have fought the exams before. In 2025, the Pharmaceutical Care Management Association and TransparencyRx filed petitions with the state's administrative hearings division, the office said in its January 2026 report. TransparencyRx's petitions aimed to stop the exams; the association later also challenged a proposed office rule.

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

What's next

What's next: By law, the office's next yearly report to the governor and legislative leaders, describing each company's violations and the actions taken, is due Friday, Jan. 15, 2027.

Sources we read

Florida Office of Insurance Regulation: Nov. 9 release and penalty table; commissioner biography; March 13, 2023 appointment release; Jan. 15, 2026 report on pharmacy benefit manager exams (copy hosted by The Capitolist). Florida Politics (Drew Wilson), Nov. 10. Florida Statutes s. 626.8828. Federal Trade Commission, July 9, 2024. Healthcare Dive (Emily Olsen), June 24. FOX 13 Tampa Bay, June 23.