CVS has been paying independent pharmacies less than the cost of the drugs themselves.
Now Florida's attorney general just forced them to open the books.
What's inside those contracts is why CVS spent years making sure nobody ever saw them.
The Closed Loop Nobody Talks About
CVS Health doesn't just run the pharmacy on the corner.
CVS Health also runs Caremark – one of three mega-corporations that together control roughly 80% of every prescription filled in America.
That means the same company deciding which drugs your insurance covers is also deciding how much to pay the pharmacy that fills your prescription.
And if that pharmacy happens to be a CVS store, the company is setting its own reimbursement rate.
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Florida Attorney General James Uthmeier dropped civil investigative subpoenas on CVS Tuesday, demanding contracts, financial audits, and rebate structures the company has spent years refusing to show anyone – and gave CVS until July 26 to hand them over.
"Here you have a situation where it appears one company has gotten so big that they are controlling market power in a way that might manipulate pricing at the cost of consumers," Uthmeier said at a Miami press conference.
"We will be looking for contracts," he added. "They never want to turn them over, but we're going to demand it."
What the Pharmacists Are Actually Saying
Dr. Aneesh Lakhani, president-elect of the Florida Pharmacy Association, didn't show up at that press conference to discuss abstract market theory.
He showed up to describe a shakedown.
"They reimburse independent pharmacies at rates so low that we are often paid less than what the drug actually costs," Lakhani said. "This is not a business model. What this is is a shakedown, and Florida's patients are paying the price."
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Johnny Meyer, owner of My Community Pharmacy in Wellington, described what he called "gotcha audits" – clawbacks where corporate PBMs pull thousands of dollars from small pharmacies over clerical errors as minor as checking the wrong doctor's name in a multi-physician practice.
Lakhani called the cumulative effect "systematic death by 1,000 paper cuts."
The result: independent pharmacies are closing, and the rural communities that depend on them most are turning into what the industry calls "pharmacy deserts."
Your 70-year-old neighbor who can't drive 40 miles to the nearest CVS is the end result of this business model.
This Is Bigger Than Florida
The FTC spent two years investigating the three largest PBMs – Caremark, Express Scripts, and OptumRx – and in September 2024 filed suit, accusing all three of anticompetitive rebating practices that artificially drove up insulin prices.
Express Scripts settled in February 2026 – a deal the FTC called "landmark" and projected would deliver up to $7 billion in patient savings over 10 years.
CVS Caremark subsequently announced it had reached a proposed settlement with FTC staff as well.
The Trump FTC's own chairman called the Express Scripts deal "a clear testament to the Trump-Vance FTC's focus on lowering healthcare costs for American patients."
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This is the federal government, the Trump administration, and now a Republican state attorney general all pointing at the same target.
States have been fighting this battle longer than most people realize – New York's attorney general went after Express Scripts as far back as 2002, and by 2015 seven separate lawsuits against PBMs were working through the courts.
The contracts CVS hid for years are finally being pried open – and what's inside them will either confirm everything Florida's independent pharmacists have been saying, or CVS will have to explain why a company with 9,000 pharmacies needed this much secrecy to run a legitimate business.
Florida Agency for Health Care Administration Secretary Shevaun Harris put it plainly: "When profits are put before people, we've seen it time and time again when one entity has too much control and power, and they abuse it."
CVS has until July 26.
Sources:
- Michelle Vecerina, "Florida hits CVS with antitrust subpoenas over predatory drug pricing allegations," Florida News, June 23, 2026.
- Fox 35 Orlando, "Florida launches investigation into CVS Caremark over pharmacy competition concerns," June 23, 2026.
- Federal Trade Commission, "FTC Secures Landmark Settlement with Express Scripts to Lower Drug Costs for American Patients," ftc.gov, February 4, 2026.
- Healthcare Dive, "CVS, FTC reach proposed settlement in insulin pricing case," March 24, 2026.
- Covington & Burling, "Federal Trade Commission Asserts Significant Anticompetitive Harms in Interim Staff Report on the Pharmacy Benefit Manager Industry," July 15, 2024.
