Florida Bar Health Law Section Health Law Update, “Florida Physicians Face Uphill Battle Obtaining Emergency Relief From Corporate Pharmacy Exclusions,” by Abbye Alexander, Esq. and Henry Norwood, Esq., 9-2026

Kaufman Dolowich’s Abbye Alexander, Chair of KD’s Healthcare/Managed Care Practice Group and Co-Managing Partner of the firm’s Orlando, FL office, and Henry Norwood, San Francisco Of Counsel, recently contributed to the Florida Bar Health Law Section’s Health Law Update, with an article discussing the challenges physicians face in obtaining emergency court relief from corporate pharmacy exclusions and how recent Florida federal court decisions have focused on the irreparable-injury requirement for temporary restraining orders. 

See the full article below:

Florida Physicians Face Uphill Battle Obtaining Emergency Relief From Corporate Pharmacy Exclusions

Under certain circumstances, pharmacies may categorically reject prescriptions written by certain physicians. This exclusion may result in immediate financial consequences to physicians, which has prompted some to seek emergency court intervention via a temporary restraining order (“TRO”).  Recent caselaw in the federal judicial districts of Florida demonstrates the difficulties physicians face in obtaining such relief.

The Corporate Pharmacy Exclusion

A corporate pharmacy exclusion occurs when a major corporate pharmacy or pharmacy chain intentionally refuses to fill prescriptions written by a specific provider. This may occur for various reasons, including a prior history of unnecessary prescribing, fraudulent prescribing, or a history of failure to investigate whether a prescribed medication may cause patient harm. From the physician’s perspective, it may not always be clear why the exclusion is imposed. The decision to reject prescriptions from particular physicians may cause immediate financial and reputational harm to physicians, prompting legal action seeking immediate relief.

Temporary Restraining Orders

The primary vehicle for a physician to obtain immediate relief from corporate pharmacy exclusions is a TRO. In the Eleventh Circuit, a court may enter a TRO “only if the moving party establishes that: (1) it has a substantial likelihood of success on the merits; (2) it will suffer irreparable injury unless the [TRO] is granted; (3) the harm from the threatened injury outweighs the harm the [TRO] would cause the opposing party; and (4) the [TRO] would not be adverse to the public interest.”^[6] Irreparable injury is often viewed as the most vital element for a TRO and the moving party must specifically establish the injury is likely to occur without the TRO.^[7] The irreparable injury cannot be speculative or remote, but instead must be concrete and imminent.^[8] The irreparable injury element has proven particularly difficult for Florida physicians to establish when seeking TRO relief from corporate pharmacy exclusions.

Recent Caselaw Demonstrates Physicians’ Struggle to Obtain Immediate Relief

Recent caselaw in Florida’s federal district courts demonstrates the difficulties in obtaining TRO relief from corporate pharmacy exclusions.

In Omega Health & Wellness v. CVS Pharmacy, the defendant-pharmacy notified the plaintiff it had instructed its pharmacists not to fill the plaintiff’s prescriptions.^[9] The plaintiff requested the defendant remove the exclusion, but the defendant denied the request.^[10] Ten months later, the plaintiff filed suit in the Middle District of Florida, seeking, in relevant part, injunctive relief.^[11] The plaintiff moved for a TRO, with the intention of afterward converting the TRO into a preliminary injunction, arguing the defendant’s exclusion would cause harm to his patients who would not receive necessary care.^[12]

Considering the TRO, the court first took issue with the ten-month delay in seeking relief that was purportedly emergent.^[13] Setting this aside, the court then considered whether the plaintiff had satisfied the second element of the TRO standard, whether the plaintiff will suffer irreparable injury absent the TRO.^[14] The court rejected the plaintiff’s argument that his patients would face harm, reasoning that third-party harm is not properly considered for purposes of determining irreparable injury.^[15] The plaintiff further argued other pharmacies had and would continue to impose similar exclusions because of the defendant’s exclusion.^[16] The court reasoned, however, that the plaintiff had not explained how the TRO would prevent other pharmacies from enforcing such exclusions and denied both the TRO and the preliminary injunction.^[17]

Fandino-Sende v. Walgreen Co. involved a plaintiff-physician who allegedly received a letter from Walgreens Pharmacy, informing the plaintiff that the pharmacy would no longer fill his controlled substances prescriptions.^[18] The letter allegedly did not provide specific reasons for the exclusion, instructed the plaintiff to inform his patients, and stated the exclusion would begin in two months.^[19] The plaintiff filed suit in the Southern District of Florida, asserting causes of action for tortious interference, injunctive relief, and due process violations.^[20] The plaintiff immediately sought a TRO, requesting the court prohibit enforcement of the exclusion.^[21]

The court scrutinized the irreparable harm element, considering two arguments raised by the plaintiff.^[22] The plaintiff first argued the exclusion would cause harm to his patients as they would be forced to choose between finding a new physician or a new pharmacy, causing administrative hurdles to patients.^[23] The court found this argument unconvincing, particularly as the defendant provided two-months’ notice before enforcing the exclusion during which the plaintiff could have arranged for his patients to find a new pharmacy.^[24] The plaintiff also argued his reputation would be harmed by the exclusion.^[25] The court was also not persuaded by this argument, finding the plaintiff had not established any concrete reputational harm, particularly as the plaintiff’s patients had already been informed of the exclusion and the court was unaware of any actual harm.^[26] Accordingly, the court found the plaintiff had not satisfied the irreparable injury element and denied the plaintiff’s TRO.^[27]

Conclusion

This recent caselaw demonstrates the challenges physicians face in obtaining emergency relief from corporate pharmacy exclusions. Courts are focusing heavily on the irreparable injury element to obtain a TRO, so counsel in corporate pharmacy exclusion cases should be prepared to address the concerns being raised by the courts.

Submitted and authored by Henry E. Norwood, Esq. and Abbye E. Alexander, Esq., Kaufman Dolowich LLP.

** This Update originally appeared in the HLS Updates publication.