Throughout the 2015 and 2016 calendar years, controversial drug price increases dominated headlines. Big Pharma was slammed en masse for sickening rate hikes.

According to The Wall Street Journal, pharmacy costs at the nation’s hospitals, driven in part by surging drug prices, peaked at $33.6 billion in 2015 alone. This marked an 11% increase over 2014. While the healthcare community as a whole was shocked and dismayed, much of the action played out in courtrooms far from public intervention.

Now a new report is offering a glance into how hospitals are using aggressively creative solutions to bring drug spending back under control and prepare for possible future increases for essential, life-saving pharmaceuticals.

To understand the need for action, it’s is important to remember that hospitals are often caught between a rock and a hard place: the status quo is a system effectively designed to disadvantage healthcare facilities.

As WSJ wrote, such institutions are being squeezed from both sides. They buy the drugs from wholesalers, but don’t usually bill health insurers directly for those drugs. “Instead, insurers often pay hospitals a fixed rate to treat whatever ailment a patient is suffering. When drug prices soar unexpectedly, hospitals must absorb the extra cost.”