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Florida Attorney General James Uthmeier has launched an antitrust investigation into CVS Health and its pharmacy benefit manager, Caremark, adding to a growing wave of state scrutiny over pharmacy benefit managers' business practices.
As part of the probe, the attorney general's office issued a Civil Investigative Demand requiring CVS Health to turn over documents and testimony related to its pharmacy benefit management practices. The demand does not represent a finding of wrongdoing or the filing of a lawsuit.
According to the attorney general's office, investigators are examining whether Caremark steered patients to CVS-owned pharmacies, reimbursed its affiliated pharmacies at higher rates than independent competitors, conducted audits that clawed back payments from pharmacies or used contracts that harmed independent businesses.
The state is also seeking information on reimbursement rates, pharmacy contracts, rebates, audits, expansion plans and whether CVS pharmacies received preferential treatment over independent pharmacies. CVS has until July 28 to comply with the demand.
CVS Health said it will cooperate with the investigation.
"We will work with the Florida Attorney General to address any concerns," a company spokesperson told Fierce Healthcare. The spokesperson added that CVS welcomes the opportunity to "set the record straight" on prescription drug pricing, arguing that drug manufacturers, not pharmacy benefit managers, determine the prices of prescription medications. CVS also said independent pharmacies remain an important part of its Caremark pharmacy networks.
The investigation comes as pharmacy benefit managers continue to face heightened scrutiny from state and federal policymakers over transparency, reimbursement practices and market concentration. Arkansas and Tennessee have recently enacted laws limiting or prohibiting PBM ownership of retail pharmacies, though those measures have faced legal challenges from PBMs and industry groups.
PBMs serve as intermediaries between health plans, employers, drug manufacturers and pharmacies, negotiating drug prices, managing formularies and reimbursing pharmacies for prescription claims. Caremark is one of the nation's three largest PBMs, and together the three largest companies process roughly 80% of U.S. prescriptions.
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