These findings potentially raise significant issues under federal antitrust law and may have important implications for PBMs, independent pharmacies, hub providers and other participants in the pharmacy industry.

On January 22, 2026, the U.S. House Judiciary Committee’s Antitrust Subcommittee staff released an interim report concluding that CVS Health and its pharmacy benefit manager (PBM) subsidiary, CVS Caremark, may have engaged in anticompetitive conduct in violation of federal antitrust laws by restricting independent pharmacies from working with third-party digital pharmacy “hubs.” The report is the product of a broader congressional investigation into PBMs and their role in prescription drug pricing.

According to the report, internal CVS documents reveal a pattern of conduct designed to undermine competing pharmacy service models rather than compete with them on the merits. These findings potentially raise significant issues under federal antitrust law and may have important implications for PBMs, independent pharmacies, hub providers and other participants in the pharmacy industry.

Pharmacy Hubs and the Competitive Landscape

Pharmacy hubs are digital platforms that provide services such as prescription coordination, benefits verification, prior authorization support, patient assistance and price transparency. They are often operated by specialty pharmacies or pharmaceutical manufacturers. The objective of pharmacy hubs is to provide services that simplify access to medications, particularly specialty drugs, while reducing administrative burdens and costs for both patients and dispensing pharmacies.

Independent pharmacies increasingly rely on hub services to compete with vertically integrated PBMs and affiliated retail pharmacies. As the hub model expanded, CVS Caremark allegedly identified them as a threat to its PBM operations and retail pharmacy footprint.

According to the committee’s report, CVS initially sought to develop its own in-house hub capabilities. However, after those efforts fell short, CVS allegedly shifted strategies from competition to exclusion. CVS essentially used its PBM network rules and enforcement mechanisms to discourage or, in some cases, entirely prevent independent pharmacies from working with third-party hubs.

Alleged Anticompetitive Conduct Identified by the Committee

The interim staff report describes several categories of conduct that, taken together, are characterized as a “pattern of anticompetitive activity,” including:

• Monitoring and surveillance of hub relationships: Internal documents allegedly show CVS tracking which independent pharmacies were working with pharmacy hubs and identifying those relationships as “competitive threats.”
• Provider manual changes and regulatory uncertainty: CVS reportedly modified its pharmacy provider manual in ways that created ambiguity around whether pharmacies could permissibly use hub services, increasing compliance risk for independent pharmacies.
• Pretextual audits and enforcement actions: The report alleges CVS initiated audits and issued cease-and-desist letters to pharmacies working with hubs, threatening removal from the CVS Caremark network.
• Leverage of PBM market power: CVS Caremark’s approximately 30 percent share of the PBM market was cited in the report as critical leverage. Exclusion from the Caremark network could prevent a pharmacy from serving nearly one-third of insured Americans—a devastating loss for independent pharmacies.

Committee staff concluded that these actions were not isolated compliance efforts, but part of a coordinated strategy to suppress competition from hub providers and protect CVS’s vertically integrated business model.

Antitrust Significance and Legal Framework

Any conduct designed to stifle competition, rather than compete on the merits, can violate U.S. antitrust laws. While the report does not reach legal conclusions on whether CVS directly violates antitrust laws, it highlights conduct that could implicate (1) Section 1 of the Sherman Act, if CVS’s network rules and enforcement mechanisms functioned as exclusionary restraints on trade, and (2) Section 2 of the Sherman Act, if CVS used its PBM market power to unlawfully maintain or extend monopoly power through exclusionary conduct.

The report also casts doubt on CVS’s asserted justifications. CVS claimed its restrictions on hub relationships were necessary to combat fraud, waste and abuse. However, committee staff characterized these explanations as pretextual, noting that CVS did not produce any evidence tying fraud concerns to legitimate hub relationships and that documented fraud issues appeared unrelated to hubs.

Broader Regulatory and Enforcement Implications

The congressional report comes amid escalating scrutiny of PBM practices by Congress, federal regulators and state attorneys general. The Federal Trade Commission (FTC) has already initiated enforcement actions against the largest PBMs related to rebate practices, and the Judiciary Committee’s findings may increase pressure for:

• Department of Justice or FTC antitrust investigations focused on PBM network rules and exclusionary contracting practices;
• State antitrust enforcement, particularly where independent pharmacies allege foreclosure from PBM networks; and
• Legislative reforms targeting PBM transparency, vertical integration and network access requirements.

Notably though, committee staff emphasized that their investigation only uncovered this conduct at CVS Caremark, potentially heightening enforcement risk against CVS relative to other PBMs. CVS responded to the report by calling it “misguided, misleading and inaccurate.”

Looking Ahead

While the Judiciary Committee’s report does not itself impose legal consequences, it adds to a growing record of congressional findings that may influence regulators, courts and policymakers as governmental scrutiny into PBMs’ conduct continues. As PBM practices continue to draw bipartisan attention, the CVS-hub allegations underscore the increasing risks associated with network rules and vertically integrated business strategies potentially strengthening the arguments by independent pharmacies against restrictive PBM practices.

We will continue to monitor developments arising from this report, including any enforcement actions, litigation or legislative responses that may affect pharmacy network participation and PBM contracting practices.

For More Information

If you have any questions about this Alert, please contact Jonathan L. Swichar, Bradley A. Wasser, Nikki Baniewicz, any of the attorneys in our Pharmacy Litigation Group or the attorney in the firm with whom you are regularly in contact.

Disclaimer: This Alert has been prepared and published for informational purposes only and is not offered, nor should be construed, as legal advice. For more information, please see the firm's full disclaimer.