A group of obscure yet powerful players in the prescription drug industry are under the microscope. On Tuesday, at a Senate hearing in D.C., the head of pharmaceutical giant Novo Nordisk blamed the health insurance industry and pharmacy benefit managers, or PBMs, for allegedly making products like the weight loss drug Ozempic way more expensive in the U.S. than it is in other countries. A few days before that, the Federal Trade Commission sued three of the country's largest PBMs for allegedly using unfair tactics to artificially inflate the price of insulin. So what exactly are PBMs and how do they work? In an episode that aired two years ago, we explain how the answer involves secret deals and double agents. Related episodes: Who can and cannot get weight loss drugs (Apple / Spotify) New drugs. Cheaper drugs. Why not both? (Apple / Spotify) For sponsor-free episodes of The Indicator from Planet Money, subscribe to Planet Money+ via Apple Podcasts or at plus.npr.org. Music by Drop Electric. Find us: TikTok, Instagram, Facebook, Newsletter.