Key Points

  • The First District Court of Appeal affirmed the Florida Office of Insurance Regulation's November 2025 order denying Clinical Specialty Infusions of Dallas, LLC's petition for declaratory statement.
  • The court held that a petition for declaratory statement under section 120.565 must concern the petitioner's own circumstances so the petitioner may select a proper course of action, and may not seek an opinion solely about how a statute applies to someone else.
  • The court held that section 626.8825(2)(g) applies only to contracts between pharmacy benefit managers and pharmacy benefit plans or programs and does not regulate pharmacies like CSI.
  • Because CSI's petition asked whether a PBM could exclude it from a specialty network, it sought an opinion about a PBM's conduct and was properly denied under rule 28-105.001.
  • The per curiam decision was joined by Judges Bilbrey, Treadwell and Neff, with no separate opinions.

A Florida appeals court on Wednesday upheld the state insurance regulator's refusal to tell a specialty pharmacy whether a pharmacy benefit manager may shut it out of a specialty network, holding that the pharmacy had asked the agency to rule on another company's conduct rather than its own.

The First District Court of Appeal affirmed an order of the Florida Office of Insurance Regulation that denied a petition for declaratory statement filed by Clinical Specialty Infusions of Dallas, LLC, which the opinion calls CSI. The decision was issued per curiam, and Judges Bilbrey, Treadwell and Neff concurred without separate writings.

Under the ruling, a pharmacy cannot use a declaratory-statement petition to obtain the regulator's view on whether a pharmacy benefit manager, or PBM, must admit it to a network under section 626.8825(2)(g) of the Florida Statutes. The panel held that the provision CSI invoked governs contracts between PBMs and pharmacy benefit plans, not pharmacies, so CSI's question concerned a manager's conduct and fell outside the narrow purpose of the procedure.

An administrative rule, rule 28-105.001 of the Florida Administrative Code, describes the device as "a means for resolving a controversy or answering questions or doubts concerning the applicability of statutory provisions, rules, or orders over which the agency has authority." The same rule states that "a declaratory statement is not the appropriate means for determining the conduct of another person."

In its petition, CSI asked the regulator whether section 626.8825(2)(g) required an unnamed PBM to include CSI in its pharmacy benefit plan or program specialty network. CSI asked the office to declare "that a PBM cannot legally exclude Petitioner, which complies with all applicable FDA standards and requirements, from a pharmacy benefits program plan or program specialty network."

The office, whose commissioner is Michael Yaworsky, denied the petition in an order entered in November 2025. The agency found that CSI sought "a declaratory statement concerning the conduct of another person," which made the petition invalid under rule 28-105.001. The office reasoned that the statute addressed "those terms that must be included in all contractual arrangements between a PBM and a pharmacy benefits plan or program."

The regulator accepted that CSI is a specialty pharmacy as defined in section 465.003(20)(a)4. of the Florida Statutes. But the agency found that CSI "does not, however, purport to be a PBM or pharmacy benefits plan or program." Because the provision relates "solely to the conduct of a PBM or pharmacy benefits plan or program, not the conduct of a pharmacy," the office concluded that the petition fell "outside the limited scope of a declaratory statement because Petitioner's question regards the conduct of a third-party PBM, not the conduct of Petitioner."

On appeal, CSI argued that it was entitled to a declaratory statement under section 120.565. The panel noted that state law requires it to affirm final agency action unless a ground listed in section 120.68(7) justifies setting the action aside or changing it. The court must remand a case if the agency "erroneously interpreted a provision of law and a correct interpretation compels a particular action," the opinion said.

The panel acknowledged that a declaratory statement may properly address a question that will be "of interest to others in the very limited group." For that point the court cited ExxonMobil Oil Corp. v. State, Department of Agriculture & Consumer Services, a 2010 First District decision quoting a 1999 Florida Supreme Court ruling.

The judges nonetheless agreed with the regulator that a petition must apply to the petitioner's own circumstances so that the petitioner "may select a proper course of action." The court wrote that a petition "may not seek an agency's opinion solely to determine the application of a statute to a person other than the petitioner," citing a 2016 Florida Supreme Court decision and a 2009 Fourth District ruling.

The panel also quoted a 2006 First District decision involving the Florida Board of Optometry to explain the procedure's purpose. That decision stated that "a party who obtains a statement of an agency's position in a declaratory statement may avoid costly administrative litigation by selecting the proper course of action in advance."

Applying those principles, the court held that the regulator "correctly interpreted section 626.8825(2)(g) as not applicable to CSI's particular circumstances — CSI's asserted wrongful exclusion from a specialty pharmacy network." The subsection applies only to contracts between PBMs and pharmacy benefit plans or programs, the panel wrote, and "Pharmacies like CSI are not regulated by the subsection."

CSI's petition therefore sought an opinion solely about a PBM's actions under a contract governed by the subsection, the court said. "CSI is not seeking an opinion to select its own proper course of action, but rather seeks an opinion about a PBM's course of action," the panel wrote.

The court concluded that CSI had failed to establish that the regulator erroneously interpreted section 120.565 when it denied the petition as exceeding the scope of a declaratory statement. The opinion affirmed on that procedural ground. It does not decide whether the statute requires a PBM to admit a pharmacy that meets FDA standards, and it does not identify the PBM CSI had in mind.

CSI was represented by William D. Hall, III of Jones Walker LLP. Gregory J. Mill, an assistant general counsel, represented the Florida Office of Insurance Regulation.

The decision is not final until the court disposes of any timely and authorized motion under Florida Rules of Appellate Procedure 9.330 or 9.331. The affirmance leaves the regulator's November 2025 order denying CSI's petition in place.