The Florida Office of Insurance Regulation (OIR enforcement announcement, Nov. 9, 2026) has issued more than $12.66 million in penalties against pharmacy benefit managers (PBMs) for not complying with Florida law. The penalties are the culmination of biennial market conduct examinations into the business and affairs of PBMs operating in the state.
OIR penalized 13 PBMs in total. The five largest penalties went to Employee Health Insurance Management, Inc. ($2.415 million), Scrip World, LLC ($2.23 million), Right Rx FL, LLC ($2.115 million), ProAct, Inc. ($1.845 million), and Capital Rx, Inc. ($1.59 million). The remaining PBMs penalized were Slate Rx, LLC ($1.36 million), Drexi Inc. ($355,000), PERFORMRX, LLC ($335,000), MC-21 Healthcare, LLC ($310,000), Benecard Services, Inc. ($60,000), CarelonRx, Inc. ($20,000), Prime Therapeutics Management LLC ($20,000), and Prime Therapeutics LLC ($5,000).
OIR’s examination reports found violations across two types of contracts – pharmacy benefit plans or program contracts, and participating pharmacy contracts. The four violation areas cited are fair pricing models, network adequacy and fair access, pharmacy remittances, and prohibition of unilateral changes to pharmacy contracts. The examinations were authorized by the Prescription Drug Reform Act, which Governor Ron DeSantis signed into law in May 2023, granting OIR the authority to examine every PBM doing business in Florida on a biennial basis.
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 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.”
The picture is not settled. OIR reports that many examined PBMs have taken, or are taking, corrective action. Others, however, are actively pushing back against the findings and pursuing litigation. Some PBMs have also declined to cooperate with the statutory examination process, and in some instances examiner invoices have gone unpaid since January 2025. OIR said it continues to evaluate each case to determine the appropriate enforcement action. Additional examinations related to other PBM contracts are also underway.
For health insurers and benefit plan sponsors that contract with PBMs in Florida, the penalties and ongoing examinations show that OIR is actively exercising its biennial examination authority under the Prescription Drug Reform Act. Carriers and compliance teams may want to review their PBM contract terms against the four violation areas OIR identified – fair pricing models, network adequacy and fair access, pharmacy remittances, and prohibition of unilateral changes to pharmacy contracts.
