Insurance Commissioner Mike Yaworsky Penalizes Pharmacy Benefit Managers Over $12.66 Million for Contract Violations

TALLAHASSEE, Fla.-Insurance Commissioner Mike Yaworsky is announcing over $12.66 million in penalties issued against pharmacy benefit managers for not complying with Florida law. These penalties are the culmination of market conduct examinations into the business and affairs of PBMS. The Office of Insurance Regulation identified violations in pharmacy benefit plans or program contracts, as well as participating pharmacy contracts. The examination reports cite violations relating to fair pricing models, network adequacy and fair access, pharmacy remittances and prohibition of unilateral changes to pharmacy contracts.<_o3a_p>

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Governor Ron DeSantis championed and signed the Prescription Drug Reform Act in May 2023 to ensure consumer protection and regulatory transparency for all PBMs doing business in Florida. OIR now has the authority to examine the business and affairs of each PBM biennially. A pharmacy benefit manager is a person or an entity doing business in the state, which contracts to administer prescription drug benefits on behalf of a pharmacy benefits plan or program.<_o3a_p>

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Commissioner Mike Yaworsky said, "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. I understand that drug-pricing can be complex, but it should never be hidden for PBMs own financial incentives. 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." <_o3a_p>

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OIR is announcing the following penalties:

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Due to these market conduct examinations, many PBMs, have, or are in the process of, taking corrective action. However, several of these PBMs are actively pushing back against OIR's findings and/or penalties and pursuing litigation. OIR's examiners are also actively completing additional exams related to other PBM contracts. The completion of certain examinations is delayed because certain PBMs are not cooperating with the statutory examinations. In certain instances, examiner invoices have not been paid by the examined PBM since January 2025. OIR continues to evaluate each of these instances to determine the appropriate enforcement action. <_o3a_p>

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For more information about complying with the Prescription Drug Reform Act, click here.<_o3a_p>