President Donald Trump’s nominee to be the next HHS secretary has government experience and is praised for having a level head, but his extensive experience as an executive for a major (and at times controversial) drug company is raising concerns that any efforts to lower drug prices will end before they begin.
Trump used his favorite platform Monday to announce Alex Azar as his next choice to lead HHS. The post has been vacant since Tom Price resigned at the end of September. Price stepped down as reporting from Politico showed he and his staff frequently took private jets to attend events on behalf of the department.
Azar still faces confirmation hearings before he is approved, but with Republicans in control of the House and Senate, it’s unlikely there will be much holdup. Here are some key facts to know and issues to watch as the nomination process continues.
Azar’s most relevant experience was his previous stint at HHS from 2005 to 2007, where he served first as general counsel and then as deputy secretary. He was appointed under President George W. Bush.
More recently, he has been in the pharmaceutical business. He joined Eli Lilly in 2007 as SVP of corporate affairs and communications. He became head of Lilly’s U.S. operations in 2012 and served in that role until he left the company this January.
Azar is a lawyer by training and once clerked for Supreme Court Justice Antonin Scalia.
Azar is described by friends and former colleagues as someone not particularly interested in politics or theatrics. He is said to have an appreciation for career government employees and a no-nonsense approach to his work.
The reaction to his nomination
Most industry groups have expressed approval of the nomination, although a bit cautiously.
The American Hospital Association said it welcomed the news and was encouraged by Azar’s experience in both the public and private sectors. “We are confident that his extensive background in business, healthcare and medicine distinguishes him as a uniquely qualified candidate for the vacancy,” the organization said.
Premier CEO Susan DeVore said in a statement the company worked with Azar when he was at HHS previously as the agency crafted early value-based payment models. “We know from that work he understands the need to move away from the perverse incentives in the Medicare fee-for-service payment system and to do so in a fashion that incents high quality care,” she said. “He also appreciates the need to have access to healthcare data and interoperability of health information systems. We are looking forward to working with Mr. Azar once confirmed.”
Former CMS Administrator Andy Slavitt, who has been frequent critic of the Trump administration, said on Twitter he doesn't know Azar well and disagrees with him on a number of policies, but still has reason to believe he would make a good HHS secretary. “He is familiar with the high quality of the HHS staff, has real world experience enough to be pragmatic, and will hopefully avoid repeating the mistakes of his predecessor in over-politicizing Americans’ access to healthcare,” Slavitt said.
Reaction in Congress went mostly as expected, with Republicans offering praise and some Democrats expressing doubt or scorn. Rep. Elijah Cummings (D-Md.) said on Twitter nominating a “former drug exec to lead HHS is like a fox guarding the hen house.” There’s little doubt Democrats will be grilling Azar during his confirmation hearing on his previous statements about drug prices and how he addressed the issue while at Eli Lilly.
His stance on industry issues
In Azar, HHS is gaining another on-the-record critic of the ACA. Azar told Fox Business earlier this year the law is “fundamentally broken” and he has shown support for repeal. As any action on the ACA has stalled in Congress, the Trump administration has taken a regulatory approach to undermining the law through executive orders and actions meant to hamper enrollment. There is no indication Azar would push for a change in that tactic.
When he has commented on the issue of high and increasing drug prices, Azar has spoken in line with other pharma execs, usually pointing the finger elsewhere.
The drug company Azar worked at for a decade has faced multiple accusations of unnecessary price hikes and of making unsupported claims about their drugs’ abilities and using those claims to make improper targeted marketing approaches.
A recently filed class action lawsuit alleges Lilly and two other drug giants continued in recent years to jack up prices for insulin products without regard for rising out-of-pocket costs for patients. Before Azar joined Lilly, the company faced charges of downplaying the side effects of its blockbuster drug Zyprexa and illegally marketing it to treat conditions it had not been approved for.
As for other issues getting a lot of attention now at HHS, less is known on how Azar would handle them. The agency has rolled back some value-based payment model initiatives and said it is looking at a “new direction” for the CMS innovation center. But officials maintain they generally support the movement toward reimbursement for value.
Azar will likely have an easy route to confirmation, but he will have a lot on his plate from the get go as he inherits a massive agency in flux with continuing changes to the ACA.