Pharmacy benefit managers (PBMs) are known as the “drug middlemen” in America’s drug prescription fulfillment system.
PBMs claim to save consumers money by offering drugs at rebate prices.
And they are quick to say they can save ‘x’ percent on prices, but we as consumers never see the savings because the prices are always going up.
Three years ago, Gov. Ron DeSantis criticized PBMs in his State of the Union address, announcing the need to lower drug prices and increase transparency.
SB 1550, by Sen. Jason Brodeur (R-Lake Mary) and Rep. Linda Cheney (R-Tampa), which passed the bill in the House, was eventually signed into law.
Although the bill had good intentions, some of the abuses that occurred then still occur today.
Meanwhile, independent neighborhood pharmacies, the proverbial “mom and pop” businesses, struggle to survive the predatory and abusive practices of PBMs.
The Florida Office of Insurance Regulation (OIR) released the Pharmacy Benefit Manager Examination Summary Report on January 15, 2026, which criticized PBMs in Florida.
Under SB 1550, all PBMs doing business in Florida must register with the state, and OIR must conduct a “systematic review to determine whether each PBM complies with all other laws and regulations applicable to PBMs” and “examine each PBM’s operations and conditions at least every other year.”
Strictly speaking, this is not a performance audit. This is just an initial inspection to ensure that the PBM is operating in accordance with state law.
However, according to OIR, “Pharmaceutical Care Management Association (PCMA) and TransparencyRx (TransRx) have filed petitions questioning the legitimacy of certain OIR actions related to PBMs.”
Okay. Everyone has the right to ensure that traffic rules are fair.
However, according to OIR, “While OIR has operated in good faith and coordinated both the PCMA and TransRx regulations, it has not yet withdrawn these challenges,” and, twisting the knife further, “…some PBMs are attempting to delay the trial through litigation and response.”
So, three years after the bill was enacted and nine months after the OIR review began, many PBMs are still battling compliance rules.
Although the case is making steady progress, OIR states that “neither TransRx nor PCMA has provided OIR with language that it believes is satisfactory. OIR is currently litigating these issues and is awaiting language that would resolve the concerns of both parties.” [Editor’s note: some compromise language was finally delivered to OIR after this Report was released, and we do not yet know if OIR is accepting the language.]
The OIR report goes on to say, “Thirty-four of the 38 reviews remain in progress. The completion of certain reviews is delayed because the PBM has not submitted the necessary contracts or documents for the review, or because the review-related invoices owed to the examiner are unpaid.”
Adding insult to injury, the report goes on to state that “eight PBMs’ exam status is ‘prevented,’ meaning they are unable to complete their PBM exams because they did not provide required documentation or did not have access to the system, and these PBMs may be subject to administrative penalties.”
Five PBMs are in “settlement litigation.” This means that these PBMs are still involved in pending litigation and may also be subject to administrative penalties.
The report also shows that 20 PBMs collectively paid more than $485,000 in testing costs to the state, and in some cases went unpaid for more than a year.
But these same PBMs own some of the world’s top insurance companies, with combined 2025 revenues of more than $1.1 trillion and PBM profits of more than $432 billion.
But they refuse to pay examiners for their work.
These PBMs treat Florida the same way they treat independent neighborhood pharmacies.
They owe money by delaying, blocking, or refusing to file documents, filing lawsuits, or refusing to pay.
This is why, on average, two independent pharmacies have closed every week so far this year.
Hundreds of pharmacies, both PBM-owned and independent, have closed across the state.
When asked by a Senate committee two weeks ago how much money PBMs saved Florida last year, PCMA representatives said they didn’t know.
This is incredible.
Florida policymakers can’t afford to just take PBMs at their word.
Tennessee wasn’t like that. They recently settled a $750,000 penalty with Express Scripts, two of the three largest PBMs that control 80% of the U.S. prescription drug market, and a $250,000 penalty with both CVS/Caremark.
Recently, the Federal Trade Commission settled Express Scripts. While litigation continues against Caremark and OptumRx, the FTC announced that the settlement agreement is expected to save consumers $7 billion over the next 10 years on the prices of some drugs, including insulin.
These measures, along with the need to curb PBM abuse in Florida, are why SB 1760 should be strengthened to give OIR pre-approval for all PBM contracts, just as OIR has authority over all insurance contracts.
OIR should also be given the ability for consumers and pharmacists to easily submit electronic complaints on the home page of the website. OIR should also aggregate that data and provide annual analysis to the Senate President, House Speaker, and Governor to help policymakers make informed, data-driven decisions going forward.
If PBMs are allowed to operate as usual, all Florida consumers, especially Medicaid patients, will continue to suffer needlessly high prescription drug costs in an opaque system that only puts more cash into the pockets of greedy PBMs.
Barney Bishop III is president of SAPR (Small Business Pharmacys Aligned for Reform), a group of independent pharmacists. He is the former Chief Executive Officer of Associated Industries of Florida (AIF), known as the “Voice of Florida Business.” He is also president and chief executive officer of Tallahassee-based Barney Bishop Consulting LLC. He can be reached at Barney@BarneyBishop.com.
