A Florida court has upheld the denial of a petition from Clinical Specialty Infusions of Dallas, LLC (CSI) regarding its request for a declaratory statement from the Florida Office of Insurance Regulation (OIR). This decision, rendered on October 21, 2026, affects CSI and potentially other specialty pharmacies seeking clarity on their inclusion in pharmacy benefit networks.
The court ruled that OIR correctly interpreted the relevant statutes and regulations, affirming the administrative order that denied CSI's petition. This ruling is significant as it clarifies the limitations of declaratory statements in administrative law, particularly concerning the conduct of third parties.
Background
Clinical Specialty Infusions of Dallas, LLC is a specialty pharmacy that provides specific medical treatments and medications. The Florida Office of Insurance Regulation oversees insurance practices in the state, ensuring compliance with applicable laws and regulations. The dispute arose when CSI sought OIR's opinion on whether it was entitled to be included in a pharmacy benefit manager's (PBM) specialty network.
CSI filed its petition in 2025, arguing that under section 626.8825(2)(g) of the Florida Statutes, a PBM must include it in its pharmacy benefit plan or program. The pharmacy claimed that it complied with all relevant FDA standards and should not be excluded from the PBM’s network. However, OIR denied the petition, stating that it was invalid because it sought a declaratory statement regarding the conduct of another entity, the PBM.
The Ruling
The court affirmed OIR's decision, stating that the agency's interpretation of the law was correct. The ruling highlighted that a declaratory statement is intended to resolve questions about how laws apply to the petitioner’s specific circumstances, not to determine the conduct of third parties. The court noted, "OIR’s interpretation of sections 120.565 and 626.8825(2) was correct. Thus, we affirm the administrative order denying the petition for declaratory statement."
Judges Bilbrey, Treadwell, and Neff concurred with the decision. They emphasized that CSI's petition exceeded the scope of what a declaratory statement can address, as it sought to clarify the actions of a PBM rather than its own legal standing.
Impact
This ruling has significant implications for specialty pharmacies and their interactions with PBMs. It reinforces the idea that pharmacies cannot seek declaratory statements to challenge the actions of PBMs regarding network inclusion. Instead, they must find other legal avenues to address grievances related to their exclusion from pharmacy benefit plans.
Furthermore, this decision may set a precedent for future cases where pharmacies seek similar clarifications. It underscores the importance of understanding the limits of administrative law and the specific circumstances under which declaratory statements can be granted. The ruling may deter other pharmacies from filing petitions that seek to address the conduct of third parties, thereby streamlining the process for OIR and reducing unnecessary administrative burdens.
What's Next
CSI may consider appealing this decision, as the court's ruling is not final until the disposition of any timely motions under Florida Rules of Appellate Procedure. However, details regarding any potential appeal or related cases were not available in the court filing.