Background
Clinical Specialty Infusions of Dallas, LLC (CSI), a specialty pharmacy, petitioned the Florida Office of Insurance Regulation (OIR) for a declaratory statement. CSI asked whether section 626.8825(2)(g), Florida Statutes, required an unnamed pharmacy benefit manager (PBM) to include CSI in a specialty pharmacy network.
OIR denied the petition in November 2025. It concluded that CSI was seeking an opinion about a third-party PBM’s conduct, rather than guidance on how the governing law applied to CSI’s own conduct and circumstances.
The Court’s Holding
The First District Court of Appeal affirmed. It held that OIR correctly interpreted section 120.565 and the declaratory-statement rule to limit such petitions to questions about how a statute, rule, or order applies to the petitioner’s particular circumstances, so the petitioner may select its own proper course of action.
Section 626.8825(2)(g) governs required terms in contractual arrangements between PBMs and pharmacy benefit plans or programs, not pharmacies such as CSI. Because CSI sought an agency determination concerning whether a PBM could include or exclude it from a network, its petition concerned the PBM’s conduct and fell outside the permissible scope of a declaratory statement.
Key Takeaways
- A declaratory-statement petition must address the petitioner’s own circumstances and course of action.
- A petition cannot be used solely to obtain an agency ruling on another person’s conduct.
- Section 626.8825(2)(g) regulates PBM-pharmacy-benefit-plan contractual arrangements, not a pharmacy’s network status.
Why It Matters
The decision reinforces the narrow procedural role of Florida declaratory statements. Regulated entities must frame their requests around the legal effect of agency-administered law on their own conduct, rather than use the process to resolve a dispute over a third party’s obligations.