On Wednesday, April 3, the Senate Finance Committee will hold its third hearing on drug-pricing this year, and five of the leading PBMs will be called to testify.

On April 3rd, pharmacy benefit managers (PBMs), the invisible middlemen of the health care industry, will be front and center for the world to see. No longer able to lurk behind the scenes, top executives from five PBMs—UnitedHealth Group's Optum, Cigna Corp, Humana Inc, CVS Health Corp, CVS Caremark, and Prime Therapeutics LLC—have been invited to testify before Congress as part of a series of drug pricing hearings examining the healthcare marketplace and soaring drug costs.

PBMs were initially set up to help control drug utilization and cost. It was thought that having middlemen specifically devoted to increasing efficiency and lowering cost that they could improve the system for everyone involved.

Unfortunately, they've just become incredibly adept at negotiating discounts and rebates from manufacturers that they then keep for themselves as profits rather than passing savings onto patients. As a result, patients are paying cost shares that do not reflect the actual lower cost of the drug, and out-of-pocket costs and co-pays have been driven far above what they otherwise would be – putting critical treatments out of reach for many patients.