Secondly, CVS is also facing tremendous challenges in its PBM business. Start-up companies with new PBM models have taken significant market shares from the incumbent PBM players such as CVS's Caremark. For instance, In August 2023, Blue Shield of California, one of the largest insurance companies in California, announced that it would terminate its 15-year partnership with CVS Health and chose Mark Cuban's Cost Plus Drug Company and Amazon Pharmacy to save drug costs for its nearly 5 million members. Furthermore, the PBM business has also faced increasing regulatory scrutiny, particularly by the Federal Trade Commission (FTC). Specifically, the FTC has raised concerns about the largest PBM's market power, especially for PBMs with the vertical integration of mail-order pharmacies such as CVS Health.