Pharmacy benefit managers are not top-of-mind for most consumers, but those big companies play a huge role in the medical market place. That's why the Senate Judiciary Committee's Antitrust subcommittee will meet Tuesday to examine Express Scripts' proposed acquisition of Medco Health Solutions for $29 billion.

The title of the 2:30 p.m. hearing sums up the debate: "The Express Scripts/Medco Merger: Cost Savings for Consumers or More Profits for the Middlemen?"

Pharmacy benefit managers are the middlemen between pharmaceutical companies, employers, employer-sponsored health plans and consumers.

The two companies argue that they save billions of dollars a year for many parts of the health-care system, and they rolled out a paid study Monday in advance of the hearing supportive of that position. One problem is there are three big PBMs, with CVS/Caremark being the other one. A merger reduces the field to two.

Others would argue that PBMs get rich at the expense of others in the system. As one retail pharmacist noted, how else would one company have $29 billion to buy another company?

If you want to watch a webcast of the hearing, that information is here.

The Bloomberg story is here.

The New York Times story is here.