Together, the two companies now manage prescription drug benefits for more than 115 million people and handle one of every three prescriptions filled in the United States. With combined revenue of more than $110 billion a year, the merged entity would also become the largest player in the domestic markets for supplying mail-order drugs to patients with chronic conditions and costly specialty drugs for conditions like H.I.V., hemophilia and rheumatoid arthritis.

Senior executives at the two companies say the merger will significantly reduce the nation’s health care costs and deliver drugs in a safer, more efficient fashion. “A combined Express Scripts and Medco will be well positioned to protect American families from the rising cost of prescription medicines,” George Paz, the chief executive of Express Scripts, told legislators at a House subcommittee hearing in September.

But some lawmakers are concerned that the merger will harm competition, and the Federal Trade Commission has requested additional information from the companies before it decides whether to approve the combination.

Tuesday’s hearing is being held by the antitrust subcommittee of the Senate Judiciary Committee. The same committee has taken a hard look at other mergers, like ATT’s proposed acquisition of T-Mobile, that have the potential to reduce competition and lead to higher prices.

Regulators are expected to focus on whether the merger of Medco and Express Scripts, which would reduce the number of major competitors to two from three, would also leave customers, particularly large employers, with too few choices and limited bargaining power. While the two pharmacy benefit managers say they face aggressive competition from other managers for their business, a recent analysis by Morgan Stanley Research indicated that the 50 largest companies in the United States rely heavily on the services of Medco, Express Scripts and the third major benefit manager, CVS Caremark.

The smaller players typically do not have the geographic reach, bargaining power or data-handling capabilities of their larger competitors, said Dan Gustafson, an antitrust lawyer who recently helped write a letter to the F.T.C. objecting to the merger on behalf of the American Antitrust Institute, a Washington organization. “These are customers who require a broad spectrum of services on a national level,” he said.

Regulators are also likely to take a look at the merged company’s potential to dominate the mail-order pharmacy and specialty drug markets. When benefit managers steer health plans to their own pharmacy fulfillment services, employers may have little choice but to agree, said Edward A. Kaplan, a benefits consultant at Segal, which advises employers and others about health insurance. “They have very little leverage,” he said.

In the area of specialty drugs, which are increasingly contributing to higher costs, benefit managers are able to profit from the difference between what employers and insurers pay for these expensive drugs and the cost. The combined company would control almost a third of the market, according to one analysis. Robert Seidman, a former pharmacy executive at WellPoint who is now a health care consultant in Los Angeles, said the merger could result in a conflict of interest in the way that the pharmacy benefit manager makes money. “We’re not talking pennies here,” he said. “We’re talking thousands” per drug.

The companies assert that there is plenty of competition with 40 benefit managers in the market, including companies like UnitedHealth Group, the powerful insurance company, competing.

Indeed, some advocacy groups support the merger. “Discouraging the collaboration of two companies that have been tremendously successful in lowering costs and increasing safety would indicate lawmakers are not serious about addressing long-term sustainability in the American health care system,” Grover Norquist, the president of Americans for Tax Reform, a group in Washington, wrote in a letter last week to the chairman of the antitrust subcommittee.

Meanwhile, a number of consumer groups including Consumers Union, along with associations representing community pharmacists, chain drugstores and supermarkets, have sent letters to regulators and legislators arguing that the combined company would create a drug benefit giant with unrivaled power. In their various letters, the groups expressed concerns that the merged pharmacy benefit manager would be likely to steer patients to its own mail-order and specialty pharmacy businesses, muscling out smaller competitors.

“Our concern is that a mega P.B.M. would have tremendous power and control over what prescription drugs Americans can get, where they get them, and how much the drugs cost,” said Don Bell, senior vice president and general counsel at the National Association of Chain Drug Stores.

DeAnn Friedholm, the director for health care reform at Consumers Union, said her group was particularly concerned that the merger could reduce consumer choice in ways such as limiting the pharmacies in their networks or requiring people to use mail order.

“We like the idea of having good choices for consumers that meet their needs, not just the need of these huge P.B.M.’s,” Ms. Friedholm said.

But, in his testimony during the House hearing, David B. Snow Jr., the chief executive of Medco, emphasized the company’s collaborative relationship with local pharmacies. “More than 85 percent of Medco customer prescriptions are filled through our network of over 60,000 retail pharmacies nationwide,” he said.

Cecelia Prewett, a spokeswoman for the Federal Trade Commission, said the agency would not comment on its examination of the proposed Express Scripts-Medco deal. She also declined to comment on the agency’s investigation of another pharmacy benefit manager, CVS Caremark, over accusations of unfair practices against consumers. CVS Caremark also declined to comment.

While the Congressional interest in the union of Express Scripts and Medco may have no direct influence on whether regulators decide to block the merger, antitrust lawyers say the hearings make it clear that lawmakers are paying attention. The Senate Judiciary Committee, in particular, has been at the forefront of examining antitrust issues, said David A. Balto, a former lawyer with the F.T.C. who is representing groups opposing the merger, including community pharmacies. He plans to testify at the hearing on Tuesday.

“By putting a spotlight on anticompetitive conduct in various markets ,” he said, “they have effectively forced the Obama administration to be a tougher cop on the beat.”

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