In the first of what will be a series of hearings on sudden price hikes of off-patent drugs, the Senate’s Special Committee on Aging on Wednesday made no attempt to veil its contempt for Turing Pharmaceuticals and its ilk.

“My biggest challenge today, is to not lose my temper,” Sen. Claire McCaskill (D-Mo.), ranking member of the committee, said in her opening statement. “The facts that are underlying this hearing are so egregious that it is hard not to get emotional about it.”

McCaskill went on to openly mock Martin Shkreli, CEO and founder of Turing, for callously raising prices while spending millions to be the sole owner of a Wu-Tang Clan album. (Later in the hearing, she simply referred to Shkreli as “Mr. Wu-Tang.”)

The committee, chaired by Sen. Susan Collins (R-Maine), announced last month that it would investigate a string of recent price hikes of off-patent drugs, which appeared to be “little more than price gouging.” Specifically, the committee requested financial documents, communications, and pricing information from four companies: Turing Pharmaceuticals, Valeant Pharmaceuticals, Retrophin, Inc., and Rodelis Therapeutics. Turing and Valeant, in particular, have made headlines for raising prices of off-patent, life-saving drugs, triggering widespread outrage. None of the companies have provided a complete set of requested documents to the committee yet.

In Wednesday’s hearing, the committee aimed to understand the effects of those price hikes on patient care, plus air ideas of how to prevent them. The senators called four witnesses, who provided examples of hospitals pulling drugs from emergency medicine carts, doctors struggling to get access to medications for sick babies, and pharmacists scrambling to find ways around the high price tags.

Erin Fox, director of drug information at University of Utah Health Care, testified that in 2013 the health system paid about $50 for each vial of nitroprusside (Nitropress), which treats severe heart failure and high blood pressure, and isoproterenol (Isuprel), which prevents fatally slow heart rates. After Valeant purchased the drugs, the 2015 price of nitroprusside was up to $650 and that of isoproterenol was $2,700.

Fox testified that those price hikes would mean the health system would have to pay about an extra $1.9 million a year to stock the two drugs as normal. To partially avoid that blow to its drug budget, hospitals instead took isoproterenol out of medical carts used in emergencies, such as when a patient goes into cardiac arrest. But doctors haven’t figured out a way to avoid using nitroprusside, which has no good alternatives, she said.

Fox tried calling Valeant in hopes of negotiating lower prices. But each time she called, the pharmaceutical company brushed her off, she told Ars after the hearing. It’s normal for drug companies to raise prices a little bit from time to time, she said, but she hasn’t seen anything like these recent drug hikes.

The problem, she and the other witnesses explained in the hearing, is that new pharmaceutical companies are buying up old, off-patent drugs like Isuprel. Often these drugs serve relatively small patient populations, offering small profits. Thus only one manufacturer may be in the business of making the drug. But once bought, new owners of the drug have a corner on the market and—as many senators put it—can hold patients and hospitals “hostage” as they raise prices to whatever they want.

One temporary solution is to use compounded drugs, witness Mark Merritt, president and CEO of the Pharmaceutical Care Management Association, told the committee. Compounding facilities typically make patient-specific formulations of drugs for, say, patients with allergies to specific ingredients or in need of unique dosages.

A compounding pharmacy was the first to offer a cheap alternative to Daraprim , a decades-old drug Turing bought that saw a price increase of more than 5,000 percent. But Merritt testified compounding is not an ideal solution, since the resulting formulated drugs can’t be mass-produced and are not FDA-approved or standardized.

That caused a problem for witness David Kimberlin, professor and vice chair for clinical and translational research and pediatric infectious disease physician at the University of Alabama. In his testimony, Kimberlin recounted how he struggled to get Daraprim for a sick baby after Turing’s price increase.

Daraprim, or pyrimethamine, treats Toxoplasma gondii parasite infections, which are life-threatening to babies and people with compromised immune systems, such as AIDS patients. If pregnant women become infected with the parasite, which can be transmitted by cats, the infection can spread to the fetus, potentially leading to brain damage, blindness, deafness, and death. About 4,000 babies are born with the infection each year in the US, he testified.

In late August, Kimberlin said he sought Daraprim for an infected baby expected to be delivered in early September. But after Turing raised the drug’s price and restricted its distribution, it was difficult to get. A 12-month treatment cost for babies went from about $1,200 to at least $69,000, he testified. For HIV-infected patients, treatment costs went from about $8,500 to at least $500,000.

A compounded drug was an option, Kimberlin testified, but this also posed problems. Babies can’t take pills; they need liquid formulations. And pharmacists have well-established recipes for making liquid versions of Daraprim, but not for new, untested compounded formulations.

Luckily, Kimberlin was able to find a pharmacy that had stocked Daraprim before the price hike, so he could buy the drug at its old, more affordable price.

The best way to solve the pricing problem is to have competition, said Merritt, the pharmaceutical association president, and the fourth witness, Gerard Anderson, director of the Center for Hospital Finance and Management at Johns Hopkins Bloomberg School of Public Health. Anderson recommended having expediting approval pathways in the Food and Drug Administration for generic drugs. Speedy approvals of generics that could bring drugs to the market in months instead of years would lower the incentives for companies like Valeant and Turing to raise prices so excessively in the first place—they might only have a few months before competition comes up with a cheaper alternative.

The idea seemed to have weight with the committee. After the hearing, Sen. Collins told Ars that she looked forward to future hearings to explore ideas of how the FDA can help. Those hearings will likely be held in early 2016.

When asked whether the committee would subpoena Shkreli and heads of the other pharmaceutical companies, Collins said she’d prefer to extend invitations first. But, Collins added, she wouldn’t hesitate to issue subpoenas if needed.