Florida has emerged as one of the most active states in pharmacy benefit manager regulation. Since 2023, the Florida legislature has enacted multiple bills that fundamentally change how PBMs operate within the state, and partially how they operate for Florida-based employers regardless of the employer's plan structure. For self-insured plan sponsors headquartered in Florida or serving large Florida populations, the regulatory landscape now matters in a way it did not five years ago.
This guide summarizes the Florida PBM regulatory framework as of 2026, the bills that built it, what's pending in the current legislative session, and how ERISA preemption affects implementation for self-insured plans.
The Florida PBM regulatory framework in one paragraph
As of 2026, every PBM operating in Florida must (1) be licensed by the Florida Office of Insurance Regulation (OIR), (2) reimburse Florida pharmacies at no less than the National Average Drug Acquisition Cost (NADAC) plus a professional dispensing fee, (3) report rebate aggregation and pricing methodology to the OIR annually, (4) refrain from steering plan members to PBM-owned pharmacies through differential reimbursement, and (5) provide audit rights to plan sponsors that meet specified statutory minimums.
HB 1509, Prescription Drug Reform Act of 2023
House Bill 1509, signed into law in 2023, is the foundational PBM reform statute in Florida. Its key provisions:
- PBM licensing requirement, every PBM doing business in Florida must register with OIR and renew annually
- NADAC-plus reimbursement floor, PBMs cannot reimburse Florida pharmacies below NADAC plus a professional dispensing fee
- Anti-steering provisions, PBMs cannot pay their own affiliated pharmacies more than independent pharmacies for the same drug
- Mandatory audit rights for plan sponsors, minimum statutory audit rights that plan sponsors must be granted in PBM contracts
- Annual reporting to OIR, PBMs must report aggregated rebate data, pricing methodology, and pharmacy network composition annually
HB 1509 went fully into effect January 1, 2024.
SB 1550 and rebate transparency
Senate Bill 1550, also enacted in 2023, extends Florida's PBM regulation with specific rebate transparency requirements. PBMs must annually report to OIR:
- Total manufacturer rebate dollars received
- Rebate dollars passed through to plan sponsors versus retained by the PBM
- Aggregate rebate per claim, by therapeutic class
- Names of rebate aggregators used and any fees paid to them
The pharmacy reimbursement floor, NADAC+
The most operationally significant provision of Florida's PBM laws is the NADAC-plus reimbursement floor. Florida law requires PBMs to reimburse Florida pharmacies at no less than NADAC plus a professional dispensing fee that meets the state-defined minimum (currently approximately $10.50 per script for traditional pharmacies).
This eliminates the most extreme MAC underpricing, the practice where PBMs reimbursed pharmacies below the pharmacy's actual acquisition cost, particularly for generics.
The PBM licensing requirement and OIR oversight
PBM licensing means OIR now has direct oversight authority. OIR can investigate complaints, audit compliance, impose fines, and suspend or revoke licenses for serious violations.
In practice, OIR enforcement has been gradual, but the existence of the oversight authority changes PBM behavior, particularly for PBMs that operate nationally and don't want to lose Florida market access.
ERISA preemption, what these laws can and cannot do for self-insured plans
ERISA preempts state regulation of self-insured employer plans in many areas. The Supreme Court's 2020 decision in *Rutledge v. Pharmaceutical Care Management Association* held that states can regulate PBM reimbursement practices.
After *Rutledge*, Florida's PBM laws apply to PBMs operating in Florida, including PBMs serving self-insured ERISA plans. The PBM must comply with Florida's reimbursement floor, licensing, and reporting requirements regardless of whether the plan it serves is fully insured, self-insured, or government.
What Florida cannot do under ERISA preemption:
- Mandate specific plan design for self-insured ERISA plans
- Require self-insured ERISA plans to use specific PBMs or specific pharmacy networks
- Override plan-sponsor contractual terms with their PBM in areas that constitute plan administration
What's pending in the 2026 Florida legislative session
The 2026 Florida session has multiple PBM-related bills under consideration:
- Enhanced specialty drug protections. Bills extending the NADAC+ reimbursement floor to specialty drugs.
- Mandatory pass-through pricing. Several bills propose requiring pass-through pricing in PBM contracts for state and local government plans.
- 340B integrity protections. Bills aimed at preventing PBMs from "clawing back" 340B discounts.
- PBM-pharmacy affiliate restrictions. Bills that would require structural separation between PBMs and their owned pharmacies.
What this means for Florida-based self-insured employers
1. Your PBM is more regulated than it was three years ago. If your PBM is operating compliantly in Florida, you're getting some baseline floor of pricing fairness on Florida pharmacy claims.
2. Rebate data is increasingly available. OIR-required PBM reports are starting to provide industry-level benchmarks.
3. The regulatory direction is clear. Florida is moving steadily toward more transparency, more pass-through pricing, and tighter PBM-affiliate restrictions.
The takeaway
Florida's PBM regulatory framework is one of the most aggressive in the country and is still evolving. For self-insured plan sponsors, the framework provides a meaningful operational floor on PBM behavior but does not replace the need for plan-sponsor-level diligence on contracts, audits, and reconciliation.